MODERN 

HOSPITALS 


THE   AMERICAN    ARCHITECT 

NEW  YORK 


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tmf.  DE  CALJF.  LIBRARY,  1:98  / 


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MODERN 

HOSPITALS 


A  Series  of  Authoritative  Articles  on  Planning 

Details  and  Equipment,  As  Exemplified 

By  the  Best  Practice  In  This 

Country  and  Europe 


By 

EDWARD  F.  STEVENS,  A.A.I.A. 

EDWARD  PEAHCE  ("ASEV.  A.A.I.A. 

(LAREXC  E  W.  WILLIAMS,  Heating  and  Ventilating  Engineer 

D.    D.   KIMHALL.   Heating  and  ^"entilnfing  Engineer 

E.  II.  UOSTOC  K 

M.  E.    .McCALM()INn\   R.N.,     Fonner  Superintendent  of  (  ivil    Hospital,    .Manila.    I'.    I. 

.\XI)     OlIIKIis 


7V)  Winch   Is  Added  More    Than  125  Full  Page  and  Text  Illiisfnifioti.' 

of  RecnitJy  Consiriicfed  Hospitals.  Their  .Irchitectural 

and    Technical  Ecjnipment 


THE  AMERICAN  ARCHITECT 

Xo.   .-,(1   rXlO.X   SC^lAUE,  XEU    NOKK 


?7 


Pre  j  ace 


/'/'  (.V  (/'(///  ///(■  itilciilion  <>f<'J)('riii</  to  (irchilicl.s  anil  tlio.sc  con- 
cerned with  the  .siijierinfciidcnfc  of  ho.s/iifdi.s  atid  the  rare  of 
the  .sieh\  .wwr  measure  of  assistance  that  this  Imn/:  has  been 
jire/Hin'd.  Its  le.rt  rejle<-ts  the  latest  leord  in  each  dc/iarlincnt 
treated,  and  the  statements  set  forth  niaij  he  tahen  as  hiiscd  on  the 
best  practice.  The  illnstrations  are  a  diverse  collection  of  irrll 
dcsiljued  hospitals  in  their  dijfercnt  special  or  iieneral  fields,  that 
have  been  recently  erected,  udiile  the  names  of  their  de.sii/ners  irill 
be  .sufficient  proof  that  theirarchitectnnd  treatment  is  of  a  character 
that  irill  afford  valuable  suyyestioiis  to  ecerijoue  entjuijed  in  tlie 
field  of  hospital  enn.ff ruction.  While  a  portion  of  the  te.vt  and 
dludrations  liave  found  precious  pnhlic<ition  in  tfie  pages  of 
The  AmeHICAX  AlWHirEvr.  mucfi  of  the  muteriid  presented 
in  this  boofi  lias  neeer  heretofore  lieen  pulilisheil .  Its  collection. 
ni  boof,-  form  presents  a  irorh  enci/clopedic  in  character  and 
recommends  it  as  a  volume  for  ready  reference.  , 


C'op.vri«lit,  \QU.  by 

'PuK   American   Architkct 

Nkw  York 


\m\^\£ 


3    C=l    □ 


MODERN    HOSPITALS 


AlUl.Nl.   I(.\l,(  ONV  AT  HKMCIILY  HOSPITAL.  BK\  KHLV.   MASS. 


DETAILS   AND   EQUIPMENT   OF   HOSPITALS* 

Bi/  EDWAUI)   F.  STEVENS,  A.A.I.A. 


HAVE  road  over  the  re- 
ports of  the  hist  tliree 
years,  as  well  as  the  re- 
ports of  otlier  papers  on 
hos|)ital  phiiininj;'  and 
coiistruction  whicli  liave 
heeii  given,  and  1  find 
that  the  field  has  l)een 
j)retty  well  covered  from 
every  }ioint.  It  may  he 
that  the  writer  of  one  ])aper  lias  insisted 
that  no  ward  shonld  he  larjier  than  six  heds, 
while  another  states  that  a  twenty-hed 
ward    is    the    hest    to   administer;    that  one 

♦Resume  of  ;ui  aiiilress  enlilled  "Dcliiils  iiiul  K<|iiipriU'tit  of 
the  Ilospifal."  Delivered  liy  >[r.  Kilwanl  V.  Stevens.  A.A.I.A., 
Before  the  .\ineriean  Hos[)ital  .Vssooiatioii  at  its  Thirtet>iitli 
.\ninial  Confereiue.  hehl  in  New  York.  SeptenilxT  19,  1911. 
Bein^  a  Report  of  the  Hospital  Construction  Committee. 


thinks  file  utilities  should  he  placed  in  a 
corner  toilet  tower  wliilc  another  helieves 
these  utilities  shdiild  l)e  placed  in  a  lo.ss 
prominent  position.  In  stndvinj;  tlie.se 
prohlems  of  hospital  plamiiiii,^  with  iiianv 
siiperintendents  in  all  parts  of  the  worhj. 
I  am  led  to  the  l)elief  that  what  mav  be 
j)erfect  and  complete  in  Xorthern  Canada 
wonld  he  siin|)ly  ridiculous  in  Florida; 
that  which  would  l)e  complete  in  (Termanv 
would  lie  lackiiii,^  in  detail  in  .Vmerica;  and 
I  believe  that  the  planniiiii-  of  the  hospital 
is  unlike  the  |)lanniiii;  of  any  other  huilding 
for  it  must  be  ileveloped  for  the  climate 
and  the  environment  in  which  it  is  to  be 
built,  and  no  rules  can  be  laid  down  which 
would  apply  equally  well  to  all  parts  of 
the  countrv. 


MODERN      HOSPITA1.S 


INTERIOR  DOOR  FINISH 

So  I  shall  not  discuss  at  this  time  the 
construction  and  phmning  of  an  hospital, 
but  shall  take  for  my  subject  the  "Details 
and  Equipment  of  the  Hospital" — com- 
paring the  American  with  the  European 
work,  and.  in  taking  this  branch  of  the 
subject,  I  will  not  be  trespassing  so  much 
on  the  field  already  covered  l)y  my  prede- 
cessors. 

I  think  it  was  our  own  Dr.  Emerson 
who  said,  in  a  paper  presented  a  few  years 
ago:  "An  hospital  building  is  a  piece  of 
medical  aj)paratus  for  use  in  the  treatment 


of  patients."  If  that  is  true  about  the  hos- 
pital building,  is  it  not  more  true  about 
the  interior  details,  the  equipment  and  fur- 
nishing of  the  hospital.'' 

By  presenting  some  of  the  things  which 
I  have  been  able  to  photograph  myself, 
or  to  secure  from  other  sources,  it  will  give 
you  some  idea  of  the  way  other  hospital 


AIRING  MALCONY.  LTKKCHr.  II(>I,1,AM) 


AMBULANCE  ENTRANCE,  BROCKTON  HOSPITAL, 
BROCKTON,  MASS. 

men    in    other   countries,    as    well    as   this, 
have  solved  some  of  their  problems. 

Construction 

The  interior  finish  and  details  of  an  hos- 
pital are  of  considerable  importance  when 
the  economic  and  hygienic  side  is  consid- 
ered, whether  finish  is  to  project  witli  edges 
and  moiddings  to  catch  dust  or  to  have  a 
smooth  surface.  In  the  modern  German 
hospitals  one  rarely  sees  any  projecting 
member,  and  I  am  speaking  now  of  the 
portion  of  the  hospital  set  apart  for  the 
care  of  the  patients. 

The  door  jamb  may  be  of  iron  or  wood, 
l)ut  it  is  sure  to  be  of  the  simplest  detail. 
The  iron  jamb  is  (piite  likely  to  be  contin- 
ued through  the  wall  and  around  the  open- 
ing in  tiles  as  is  well  illustrated  in  the 
private    hospital    of    the    "Merchant"     in 


MOD  !•:  i{  \     II  OS  ri  r A  r,s 


M.\TKI{MI^    WAUI),  IJ'l'HW  IIT 

Vienna,     or     in     tlie     plain     fini.sJi     at     St. 
(ireorg's  in   Ilanihnrg. 

Bnt  wliiio  this  finish  aI)()V('  tlio  flooi'  in 
the  rorciyn  hospitals  is  \vell-ni<ih  |»('rl'('(t, 
the  j()inin<;'  of  tlie  door  jamh  to  the  floor 
in  iHNirly  everv  hospital  which  I  visited  in 
Europe  is,  to  my  nund,  verv  had,  as  it 
leaves  an  untidy  anj;le  impossible  to  dean. 
If  this  door  jand)  is  cut  away  and  the  ltas(> 
earried  llirouj;h  as  is  shown  in  the  illustra- 
tion, whicli  was  taken  in  (Iraee  Hospital 
at  Detroit,  it  is  almost  impossihle  for  any 
dirt  to  eolleet.  This  base  and  jamb  is  set 
before  plastering,  so  that  every  part  of  the 
finish  is  smooth  with  the  wall.  This  same 
character  of  finish  should  also  be  applied 
to  the  windows.  The  American  door  man- 
ufacturers certaiidy  make  better  and  more 
sanitary  doors  than  in  any  country  I  have 
visited.  The  one-|)anel  or  no-panel  "slal)"" 
doors  now  beino-  used  in  the  modern  .\meri- 
can  hospitals  are  to  be  preferred  to  those 
used  abroad.  The  hardware  is  a  small 
item  but  should  always  be  selected  for  its 
suitability.    The  an^le  door  knob  or  handle. 


as  .seen  in  the  (icrnian  hospitals,  has  many 
advanianc's  over  the  frlass  knob.  Invisible 
liin<;('s,  bo.\ed  strikers  and  non-projectinfi 
haniware  can   be  used  to  advantage. 

'i"he  ever  prcMMit  (|uesti()n,  "AVliat  is  the 
besj  floor.'"'  is  often  met  with  antl  i^  hard 
to  answer,  '{"his  (|neslioti  I  a^ked  of  llie 
leadiiii;-  architects  and  hospital  men  in 
Knrope  and  the  almost  universal  prefer- 
ence seemed  to  be  fur  lile.  ,i  light  grev  peb- 
ble linish  vitreous  tile;  llic  next  favorite 
lor  a  hard  or  dense  floor  was  terraz/.o. 
while  one  would  see  evervwhere  on  the 
Continenl  llie  Battleship  linoleum.  This, 
cemented  as  it  was  to  the  constructi(jn  and 
laid  against  a  tile  base,  made  a  very  hy- 
gienic,   noiseless    floor.      One    wouhl    liardl\ 


HKVOlA  l\(i  liAl.coN^,  I  I'liii  irr 


SOrAUICM,    CORKY    HILL   IIO.si'ITAL,    HIJOOKLINK. 

ever  see  wood  used  for  floors,  while  lino- 
leum Avas  used  not  oidy  for  floors  but  for 
table  tops,  stair  treads,  .screens  and  even  for 
door  panels.  In  my  own  practice  I  have 
found  that  linoleum  is  the  best  all-around 
ward  or  private  room  floor  becau.se  of  its 
noiseless  and  .sanitary  (jualities. 

The  exterior  details  of  th(>  hospital  are 
important  but  should  be  made  subservient 
to  and  expressive  of  the  plan  and  to  fulfill 
the  mission  of  the  hospital.  The  entrance 
should  be  dignified  and  express  its  use  as 
far  as  |)ossil)le. 

The  pnnailing  idea  of  surgeons  and  phv- 
sicians  that  the  patients  should  be  in  the 
open  air  as  nuich  as  po.ssible  makes  it 
necessary  for  us  to  design  airing  balconies 
and  roof  wards.  The  hospital  at  Utrecht, 
in    Holland,    has    many    excellent   features. 


3 


MODERN      HOSPITALS 


(iKNKKAl,  WAIJD  AT  BKVKRLY  HOSPITAI,.  l!KVi;i!l.V. 
MASS. 

one  of  them  being  the  extensive  airing 
balconies.  These  airing  balconies  are  used 
very  extensively  wherever  they  are  provided. 
The  roof  wards  are  used  extensively  in  this 
country.  Provision  should  be  made  in 
these  roof  wards  for  diet  kitchen  and  toilets 
the  same  as  for  regular  wards  so  that  the 
patients  could  l)e  cared  for  night  and  day 
if  necessary.  The  airing  balcony,  however, 
cannot  always  l)e  in  the  sun  and  the  clever 
director  of  the  T'trecht  Hospital  has  had  a 


M  Al  ,K  W  A  I!  1 ),  1 1  i;V\V( )( )1)  IIOSPITAI..  ( ;  ARDN  KM,  M  ASS. 

revolving  l)alcony  built,  wliicii  follows  the 
sun  or  can  l)c  placed  to  shield  the  pallcul 
from  the  wind. 

The  .solarium  is,  of  course,  useful  as  a 
day  room,  but  unless  well  vciitiialcd  is  apt 
to  get  very  "stuifv."  It  can  be  made  at- 
tractive with  j)alms  and  flowers. 

Whv  not  make  the  whole  ward  a  solari- 
um, as  was  done  at  the  Beverly  llospilal.' 
The  windows    made    large,    extending  low 


enough  .so  that  the  patient  could  look 
out  while  Iviu":  in  bed,  and  hioh  enoujrh  to 
.secure  the  maxunum  ol  sindight.  In  the 
European  hospitals,  ca.sement  windows  are 
used,  as  well  as  transoms,  but  one  hardly 
ever  .sees  the  unsanitary  roll  shades.  The 
wa.shable  linen  curtains  are  u.sed  and  make 
the  ward  much  more  homelike. 

Artificial   lighting  for  the  general   ilhimi- 


(;i,.vzi'.i)  Diviui.vc;  PAUTirioxs,  isolating  di;- 

I'AHTMENT,   JOHNS  HOPKINS  HOSPITAI. 

nation  of  the  ward,  using  a  reflecting  light, 
is  much  less  trying  to  the  patient 

Note  in  the  illustration  of  the  Ileywood 
hospital  that  the  ward  is  flooded  with  sun- 
shine, as  each  bed  is  near  a  window. 

In  the  (lerman  and  Holland  maternity 
hospitals,  the  babies  are  always  kept  in 
the  same  room  with  the  mothers  and  the 
draping  of  the  bassinets  is  sometimes  (|uite 
grotes([ue.     This    hospital    at    I  treclit    was 


()1HI.|{\M'|()\    WAIil).    Cllll.DltKNS    ItllLDIXC;. 
.lOllNS  HOPKINS  IIOSPITAI, 


M  ()  I)  i;  w  \     II  OS  n  r  A  i,s 


7 


•'Wt''; 


■p^sacaa:.. 


lir.ATi;!)     I'OOl)     W  \(.()N.    A.MSri;i!l)AM     IIO^I'IIAI. 

one  of  tlic  Ix'st  i'(|ui|)|)('(l  tli.il  we  s;iw.  (  Ndic 
here  a<>iiiii  tlie  reHectcd  lii;lit.) 

In  the  illustration  of  the  interior  of  Johns 
IIo|)kins  Hospital,  it  will  he  noted  thai  Mr. 
IJntler  lias  used  the  glazed  dividing  |)artitions 
for  the  rooms  in  tlie  isolating  department, 
similar  to  that  seen  in  the  I'asleni'  at  Paris. 

The  ob.servation  ward  of  this  institntion 
has  the  unique  feature  of  having  in  the 
same  room  children  infected  witii  different 
diseases,  for  observation  purposes,  dividing 
the  cases  only  by  a  glass  ])artition  some 
eight  or  nine  feet  high.  Scrub-up  bowls 
occur  along  the  outsitle  wall.  'I'here  is  a 
free  circulation  of  air  everywhere  and  why 
is  this  not  a  simple  solution  of  a  small  con- 
tagious hospital?  Perhaps  the  cubicals  like 
the  Pasteur,  where  one  room  is  absolutely 
cut  off  from  another,  would  be  a  little  safer; 
but  1  believe  that  for  the  small  contagious 
hospital,  there  is  no  necessity  for  separate 
buildings  for  the  difl'erent  diseases;  for  with 
proper  isolation  of   the   buildings  and   pre- 


caulinri  In'  ev«'r\one  \isiling,  and  the  ob- 
ser\ancc  of  lli<-  la\ss  of  antisepsis,  these 
casc>  ^l|ollll|  be  as  safcK'  cared  for  without 
danger  fiotM  cross  infection  as  in  separate 
Itiiililings. 

Of  course,  all  utensils,  china,  and  <-verv- 
Ihitig  about  ilie  patients  should  be  stcrili/.cd. 
and  ill  lliisway  there  should  be  no  necessity 
for  keeping  the  china  of  flic  difl'crcnf  cases 
separali'. 

( )ii  I  lie  ( 'dill  liiciil  (]iir  sccs  \-cr\'  ivw  tuirses 
bed-side  calls  cillirr  bclU  or  otherwise. 
'I'he  |)aticnt  iiiiisl  wail  iiiilil  tlir  nurse 
makes  her  rounds.  In  an  .Vnicric.in  hos- 
[)ital,  ho\\c\fr,  nurses"  calls  from  tlie  pa- 
tient's Ix'd  seem  a  necessity.  I  cannot 
recommend  too  strongly  the  doing  away 
with  the  nois\  clamor  of  the  ordinary  call- 
iiiir    svstem    for    IIk-    iiursc    and    doctor.      1 


ori.KAriXCi  Itl  ll.DING.  ST.  GKORGS.  IIAMHIRG 


STKRILIZINC;  ROOM.  BKTWKKN  ASKFl'IC  AND  CLK.\N 
ROOMS   SI'.  GKORGS,  HAMBURG 

think  the  liell  system  should  be  relegated 
to  the  shop  and  factory  where  noise  is  ex- 
pected, as  noise  i)egets  noise,  and  no  matter 
how  numv  "Silence''  signs  there  are,  if  the 
electric  call  bell  is  rung  whenever  a  patient 
wants  to  turn  in  bed,  there  will  be  other 
noises  to  drown  the  .sound  of  the  bell. 
With  the  simple  devices  of  electric  light 
calls  now  on  the  market,  the  working  of 
which  is  simpler  than  the  electric  bell  it- 
self, 1  think  the  system  should  be  .so 
arranged  that  the  patient  after  once  pre.s.s- 
ing  liic  Ituttoii  could  iu)t  cancel  the  call, 
and.  at  the  same  time  the  nurse  should 
onlv  have  to  go  to  the  patient  and  not  to 
the  wall  behind  the  bed  to  cancel  it.  A 
svstem  of  this  nature  has  just  been  installed 
in  the  Grace  Hospital  at  Detroit.     A  simi- 


MODERN      HOSPITALS 


OPERATING  ROOM,  DRESDEN  HOSPITAL.     SINGLE  LARGE  REFLECTORS  ARE  USED  IN  ALWY  ROOMS 


liLFIJXTKD  LKilir.  ITRECIIT 


lar  system  for  calling  the  internes  was  also 
installed;  the  signals  are  set  from  the  main 
office  and  bv  difierent  colors  and  positions  of 
electric  hnlhs  the  different  doctors  are  sig- 
nalled to  answer.  They  go  to  the  nearest 
honse  'phone  and  call  the  office  for  instruc- 
tions, then  the  call  is  cancelled. 

The  conveying  oi  food  from  kitchen  to 
patients  is  a  very  important  item  in  hos- 
pital economics.  In  the  great  Steinhof  at 
Vienna,  where  .S,()()()  patients  are  scattered 
over  3.50  acres  of  land,  the  food  is  carried 
in  electric  cars  and  in  an  incredihly  short 
time  is  in  the  various  serving  rooms.  In 
the  smaller  hos|)itals,  push  cars  are  used. 
At  I  trecht,  this  was  a  heated  car,  while 
in  some  of  the  (ierman  hospitals  the  two- 
wheel  cart  with  caus  hung  upon  the  high 
rails  were  used.  While  the  siuiple  open  car- 
rier is  sufficient  for  short  distances,  I  be- 
lieve that  a  food  carrier  made  on  the  prin- 
ciple of  the  Hreless  cooker  should  be  used 
for    long    distance    transportation. 

The  cfpiipment  of  the  sink  room  is  grow- 
ing   in    importance    with    every    new    hos- 


6 


MODKIJX      IIOSPITAI.S 


■  ADDITION  TO- 

•GRACC-ZIOiPlTAL- 

•DETROIT-      MICHIOAM- 
EOWA».0-r-.3TEVeN5    AE.CHITtCr 
&OSTOA<-  -A1AJ5  ACH  USCTT5- 


pital.  Less  is  made  of  this  room  in  the 
European  hospitals  than  our  own.  The 
sink  room  becomes  the  work  room, 
the  Uil)oratorv,  tlie  repository  for  all  dirty 
ward  work.  In  this  room  there  should  be 
the  sterilizers  for  stools  and  bed  jians; 
these  with  the  automatie  lifts  make  the 
work  of  absolute  cleanliness  nnich  easier. 
also  the  ward  incinerator  (and  this  I  coii- 
sider  almost  a  necessity  in  the  modern  hos- 
pital);  and  the  sinks,  the  blanket  warmers, 
the  bed-pan  warmers,  the  mops  and  brooms 
for  cleaninj);  are  all  essential.  This  room 
should  have  large  doors  and  above  all 
things  should  be  well  ventilated,  lighted 
and  heated. 

OpER.VTING    BriLDIXG 

It  was  a  very  noticeable  feature  tliat  even 
in  the  large  (jcrman  hospitals  there  were 
but  few  operating  rooms  as  comparcfl 
with  the  numl)er  of  j)atients.  Even  in  the 
great  ^  irchow  there  were  but  four.  In 
the  St.  Georg  Hospital  there  are  I)ut  two — 
a  clean  and  a  septic.  In  the  clean  opernt- 
hm  room  the  walls  on  two  sides  and  ceiliiii: 
are  of  glass  and  double,  with  spaces  be- 
tween for  heating  of  these  rooms.  The 
sterilizing    room     is     placed     between     the 


septic  ;iiid  clean  I'ooins 
entering  from  the  clean 
anfl  from  the  corrirlf>r, 
there  being  windows,  how- 
ever, into  both  rooin>,  and 
at  those  windows  ai'c  the 
inst  rn  men  t  '^t(•^il  izers, 
w  hich  (-Jill  |j(-  i-c;i(-Im-(|  with- 
out lca\ing  III*'  Dpcratiiig 
rooms.  The  aiijc-tliclic 
room  a  bo  joins.  'J'he  ar- 
tificial lighting  is  a<-com- 
plislu'd  b\'  means  of  three 
domc-sha|)ei|  ceiling  fi.v- 
tures  with  numerous  high 
candle-power  lamps. 

In  other  (iermati  hf)s- 
pitals  single  large  reflec- 
tors were  used  in  the  op- 
erating  room. 

I  have  used  the  type  of 
fixture  shown  in  the  ilins- 
tratioii  with  good  .success. 
This  shows  a  crane  swing- 
ing to  the  centre  of  an 
eighteen-foot  room;  this 
fi.xture  at  the  Beverly  Hospital  has  the  ad- 
vantage of  being  swung  back  out  of  the 
way  and  leaves  no  dust-retaining  surfaces 
above  the  operating  table,  and  can  be  raised 
or  lowered  at  will. 

We,  in  onr  investigations  al)roa<l.  found 
that  the  reflected  light  from  a  high  power 
arc  lamp  in  an  adjoining  room.  >hining 
through  an  opening  in  the  wall  and  re- 
flected from  one  mirror  to  another  and 
thence  to  the  seat  of  operation,  was  very 
successful. 

I    believe    the    day    of    the    large    amphi- 


.V.-iaTll-  U1'1.1;A11.\u  UtKJ.M.^r.  L.L01;(-.  ^.;lA.^liiLKG 


.MODERN      HOSPITALS 


OPERATING   ROOM,  SHOWING  CRANE.  BEVERLY  HOSPITAL.  BEVERLY.  MASS. 


theatre  for  major  operatioiLs  is  past  and 
the  .smaller  room.s  with  movable  oliserva- 
tion  .stands,  where  the  student  or  observer 
can  get  near  the  patient,  should  take  its 
place.  'I'he  view  of  the  Douglas  Operat- 
ing TJuilding  at  Brockton  shows  a  room 
wliicli  I  l)elieve  is  the  most  compact  and 
servic-eable  I  have  ever  seen  on  this  con- 
tinent or  the  (»ther. 

No  hospital  nowadays  is  (piitc  complete 
without  its  i{oentgcn  or  .c-Ray  room  and 
apparatus.  The  styles  and  sizes  of  the 
ap|)aratus  and  character  of  the  work  done 
varies  with  the  institution.  'I'hc  Uocntgcn 
Institute,  as  this  department  is  called  in 
the  (icrman  hospitals,  is  made  nnich  of 
occupving  in  tiic  case  of  St.  (Jeorgs  the 
entire  second  st(»ry  of  the  operating  build- 
ing. 

Bath  House 

Occu|)ying  a  position  of  c(|nal  im|)ort- 
ance  with  the  operating  department  in  the 
(ierman    hospitals   is   the    bath    hou.se,   this 


building  occupying  the  same  relative  posi- 
tion on  the  medical  side  that  the  operating 
buildiu"'  does  on  the  suroical.  In  this 
building  are  located  the  various  baths  as 
will  be  seen  by  the  plan,  with  its  electric, 
steam,  sand,  douc-he,  brine,  CO2  (carbon 
di(»\'i(le),   hydro-electric,  etc. 

I  thoroughly  believe  that  in  America  we 
should  do  more  for  the  medical  side  of  our 
statt"  in  the  way  of  sj)ecial  rooms  and  equip- 
luent  for  baths,  muscular  develo{)ment  and 
exercise  of  various  forms.  It  is  not  un- 
conunon  on  the  Continent  to  .see  a  well- 
e(|uipped  gymnasium  and  mechanical  mas- 
sagi'  room  in  an  hospital. 

'i'he  method  of  sterilizing  and  tempering 
the  air  in  the  St.  (ieorg  operating  room  was 
most  interesting.  In  the  section  shown 
through  the  major  operating  room  you  will 
notice  that  the  outer  sash  is  double  and  air 
is  conducted  entirely  around  this  hollow 
space  warming  in  winter  and  cooling  in 
snnuner,   the   Hoor.   the   walls  and   the  ceil- 


MOD  K  l{  \       ll<)>  1'  I   r  A  I.S 


irifj.  Additional  lical  in  winter  is  seemed 
from  direct  radiators  heliind  thin  nickel 
jilales  in   the  walls  as  shown   ni   |  ili<  ilo<^fa  |  )li . 


OI'Kl!  VI'INc;    liOOM.  ItltOCKTON    IIOSIMIAI,, 
lil!()(  KION.   MASS 

l)ul  all()\viii<;'  no  air  Ironi  tlii>  >onrcc  to 
enter  the  rooms.  'I'lic  air  for  the  operatiiij.^- 
rooms  is  first  hrontiht  into  a  clean  cliandx'r 
where  it  is  passed  tliron^li  ground  coke, 
thence  over  heated  coils  in  winter  and  ice  in 
summer,  fliron^li  into  the  fan  where  it  is 
driven  tlironi'li  a  filterini'  snhstance  of 
fine  sand  and  yravel  and  tlience  taken  to 
the  operating-  rooms  |)raclically  free  from 
all  bacteria.  The  ceilino-  vents  in  the 
operating  rooms  are  closed   and    there   is  a 


\-KAV    UOO.M,    ST.    GEOKGS.    IIAMIUIU; 

sufficient  pressure  outward  so  that  the 
openiiiji;  of  any  door  would  not  admit 
any  foul  air.  'This  may  have  heen  carried 
to  a  refinement  heyond  what  would  l)e 
necessary  to  follow,  I)ut  it  certainly  seemed 
a  well  developed   plan. 


II I  ■  1 1  \'. 

While  it  i-  not  ni\  iiilcntiDn  to  '^i)  into 
he  sul)|e(t  of  he;itiii;^  ami  \eritilation  of 
lospilaU.  ;i-  that  i>  loo  hroarl  a  sulijcct 
o  take  n|j  heic  at  thi>  time,  still  I  want 
o  present  a  lew  simph-  way-  which  have 
lecn    called    to    m\    attention. 

W    the    l''ranz    .lo-ef    hos|)ital    at     \  ieniia 
the   eoniliinalion    shown    in    the    ilhi>trafion 


I'ltivvn;  itoo.M  wash  hasin.  (iUAci;  iiosimiai.. 

DrrUOIT.  MICH. 

is  used.  This  .section  seems  s(>If-e\plana- 
tory;  either  the  air  comes  from  dnct>  helow 
— passing;  over  the  radiators,  or,  liy  man- 
ipulatini;'  the  valves,  the  air  of  the  room  is 
circulated.  I  noticed  that  in  the  (ieneral 
Hosiiilal    at     \'icnna    a    svstem    of    "direct- 


OUiFXT-IXDIRECT  RADI.Vno.N".  QIINCY  HOSPITAL. 
QITNTV.  M.\SS. 


MODERN      HOSPITALS 


indirect"  heating  was  adopted  for  nearly 
all  the  rooms  and  corridors,  introducing  the 
fresh  air  from  outside  at  the  top  of  the 
direct  radiator,  de{)ending  on  the  natural 
tendency  for  cold  air  to  drop.  Let  me  say 
that  I  am  for  simple  forms  of  heating  and 
ventilation  for  hospitals,  for  who  wants  to 
breathe  air  at  a  certain  even  temjjerature 
all    day.-     The    patient    in     bed,    covered 


ft 


PLAN  OF  BATH  HOUSE,  ST.  GEORGS,  HAMBUR<. 

with  blankets,  does  not  need  the  tempera- 
ture at  seventy  degrees  or  seventy-five  de- 
grees and  is  not  comfortable  with  it.  My 
old  professor  of  ventilatit)n  used  to  say  the 
ideal  temperature  was  that  of  a  beautiful 
June  day  in  a  pine  forest  in  New  England; 
l)Ut  this  would  not  be  at  just  sixty-five 
degrees  or  sixty-eight  degrees  for  the  twelve 
hours,  as  it  would  l)e  varied  with  the  move- 
ment of  the  air.  A  system  should  be  used 
which  would  be  as  near  "fool-proof"  as 
[)ossible  and  not  de|iendant  on  mechanical 
means  altogether. 


WHEEL  STRPrrCHERS,  (iTRECHT 

10 


STOCK  KETTLES  L\  KITCHEX  OF  ST.  GEORG'S  HOS- 
PITAL, HAMBURG 


Plumbing 

There  is  perhaps  nothing  more  impor- 
tant in  the  equipment  of  an  hospital  than 
tlie  plumbing,  for  through  the  pipes  go 
all  the  filth  and  product  of  disease  and 
it  is  most  important  that  this  plumbing 
work  be  done  well  and  that  all  pipes  and 
fixtures  on  the  room  side  of  the  trap  at 
least  be  get-at-able  for  cleaning  not  onlv 
the   outside,    but   the    inside   as   well,    that 


r    ■  p 


C3 

DD 

CZZ) 


FnschluftUansI 


ASEPTIC  OPERATING  ROOM,  SI'.  GEORG'S.  HAMBURG 

enough  space  around  the  fixtures  should  be 
allowed  tor  cleaning  and  the  simplest  form 
of  brackets  and  su|)port>i  used. 

The  bath  tub  for  the  patient  should,  I 
think,  be  constructed  as  to  allow  the  pos- 
sibility of  filling  it  in  the  shortest  possible 
time.  'I'lie  large  inlet  itlea  like  the  ocean 
steamship  tul)s  ;i|)peals  to  me.     The  over-flow 


M()1)KI{\       IIOSI'IIALS 


(if  there  must  Ik:  one)  .sliould  be  sueli  that 
it  can  1)6  easily  cleaned;  if  the  trap  is  set 
above  the  floor  the  watiT  line  is  within  easy 
reach  of  the  hand  and  the  |)ii)es  can  all  be 
cleaned  inside.  This  tub  should  be  set 
high — making  it  easy  t"or  the  inirse  to  assist 
if  necessary  in  the  bath.  With  the  "bug-a- 
boo"  of  sewer  gas  exploded,  there  is  no 
reason  why  the  private  room,  at  least, 
should  not  have  a  wash  basin.  In  a  type  1 
have  used  in  the  (irace  Hosj)ital,  the  bowl 
and  even  the  shelf  and  towel  rack  are  away 
from  the  wall. 

The  simpler  form  of  surgeons'  scrul)-U|) 
sinks  appeals  to  me,  doing  away  with  the 
c(miplicateil  foot  and  knee  valve  which  has 
come  into  popularity  within  the  last  ten 
years  and  having  the  simpler  elbow  valves 
for  the  non-hand-touching  valve  is  only 
wanted  after  the  surgeon  has  done  his 
scrubbing-up.     A  page  from  the  catalogue 


of  a  (jcrinan  in.>trunifnt  maker  show.-,  the 
develo|)ment  of  the  elbow  valves  and  the 
simple  brackets  and  supports.  The  sur- 
geon can  turn  on  the  water  lo  the  desired 
tem|)erature,  scrub  his  ten  or  fifteen  min- 
utes, then  with  a  push  of  the  elbow  or 
shoulder  the  water  is  shut  off. 

I  have  referred  in;iii\  liiiic>  to  the  St. 
(ieorg  Hospital  at  Ibimiinrg.  I  have  done 
this  for  two  reasons:  first,  that  tlic  ;iv;iil- 
ablc  material  was  better,  and  scroinl.  tli;il 
the  St.  (Jeorg  embodies  the  gn-afcr  nunilxi' 
of  new  and  *'u|)-lo-dale"  ideas  that  1  Found 
in  m\  visits  to  over  thirty-five  lios|)itals 
in  Europe. 

I  desire  to  make  acknowledgment  to  the 
architect,  the  man  whose  study  and  knowl- 
edge of  the  hospital  problems  has  devel- 
o|)ed  some  of  the  finest  things  in  this  line 
in  Germany,  and,  I  believe,  in  the  world, 
liaurat  Dr.  K.  I{iippel. 


MODERN   PRACTICE   IX   HOSPITAL   HEATING   AND 

VENTILATION* 

«//  CI-.\RENCE  W.  WILLIAM.S 


N  this  article  it  is  the 
purpose  of  the  writer  to 
describe,  in  general,  vari- 
ous tyi^es  of  heating  .sys- 
tems which  have  been 
adopted  in  modern  hos- 
j)ital  practice  and  where 
they  slioiUd  or  should  not 
be  u.sed.  Only  such  sys- 
tems as  are  applicable 
to  the  larger  institutions  will  be  considered, 
as  those  in  the  snudler  class  of  buildings 
depend  more  upon  the  resources  of  the 
in.stitution  than  uj)on  their  capability  of 
economical  o[)eration. 

It  is  unfortunate  that  the  economical 
side  of  the  selection  and  design  of  heating 
and  ventilating  apparatus  has  not  been 
given  greater  thought  and  study;  but  it  is 
the  prevalent  idea  that  so  long  as  it  is  pos- 
sible to  use  the  exhaust  steam  from  an  en- 
gine in  a  heating  system,  further  economy 
IS  impossible  and   if  that  condition   is  fuj- 

*An  address  deliveivil  iM'furc  llu-  N:iliiMi;il  IIn-|Ml:il 
.\s.socialioii. 


tilled,  then  tiie  only  thing  that  renuuns  is 
to  in.stall  the  system  that  costs  the  least, 
regardless  of  the  operating  cost. 

Considering  first  the  compact  or  .single 
block  hospital,  the  system  generallv  in- 
stalled is  that  using  low-pressure  .steam 
through  the  building.  In  this  tvpe  of 
heating,  exhaust  steam  is  w^vd  with  a 
l)ack  pressure  on  the  engines,  varving  ac- 
cording to  the  merits  of  design.  The  de- 
ficiency in  the  exhaust  .steam  is  supple- 
mented by  live  steam,  delivered  through  a 
pressure-reducing  valve.  We  have  learned 
by  experience  that  for  this  type  of  building 
such  a  system,  if  well  designed,  with  mains 
of  ample  size  so  pro})t)rtioned  as  to  provide 
a  perfect  circulation  with  one  pound  pres- 
sure and  to  heat  the  entire  building  in  the 
very  coldest  weather  with  not  more  than 
five  pounds  [n-essure,  gives  good  results 
with  a  smaller  initial  cost  than  any  other 
type  of  heating  s\stem.  There  is  tlie  same 
fault  with  this  as  with  every  other  steam 
system— namely,  that  of  heat  regulation, 
which    is   practically    impossible  exc-ept    bv 


11 


MODERN      HOSPITALS 


the  addition  of  a  temperature  control. 
This,  as  it  rehites  to  fuel  economy,  will  l)e 
considered  later. 

Where  there  is  more  than  one  main  hos- 
pital Ijuildino-  and  the  buildings  are  widely 
separatefl,  the  low-jjressure  steam  system 
is  not  so  well  adapted  to  these  conditions 
if   true   economy    and    first   cost   he   consid- 


SERVICE  BUILDING,   STAMFORD   HOSPITAL,   STAM- 
FORD, CONN. 

ME.SSRS.   GEORGE   D.    POST   *   SONS,    ARCHITEnS 


ered.  for,  if  it  is  desired  to  keej)  the  hack 
pressure  on  the  enoines  within  rcasonahlc 
limits,  the  heatinj;-  nuiins  must  he  very  laroe. 
On  the  other  hand,  if  the  mains  are  not 
properly  |)ro])ortioned  for  load  friction  and 
condensation  losses,  or  if  made  too  small, 
then  the  back  pressure  on  the  engine  is  in- 
crea.sed,  with  a  consequent  reduction  in 
power  and  incTcase  in  steam  consumption. 
There  are  many  types  of  vacuum  sys- 
tems— .so  many  that  it  is  hard  even  for 
heating  engineers  to  keep  informed. — and 
of  the.se  there  are  but  two  types  whicli  are 
in  general  use.  One  type  docs  nothing  but 
remove  the  air  from  the  radiators  tlirougli  a 
.system  of  air  pipes,  they  in  turn  being  con- 
nected to  a  vacuum  |)um|)  or  an  injector. 
Its  advantages  consist  of  the  removal  of 
air  from  the  radiators,  thus  increasing  their 
efficiency,  the  reduction  in  size  of  tlic  pi|)ing 
and  the  reduction  of  fin'  back  pressure  on 
the  engines  becau.se  of  llic  vacuiini  in  llic 
air  line  .system.  In  a  wcll-dcsigncd  low- 
pressure  steam  plant  the  addition  of  such  a 
.sy.stem  is  really  unneces.sary,  according  lo 
the  writer's  opinion,  especi;illy  if  the  auto- 
matic air  valves  are  comicctcd  to  air  lines 
which  are  connected  together  and  discharge 


into  a  convenient  receptacle  in  the  basement, 
thus  doing  away  with  unpleasant  odors 
and  discharge  of  steam  and  water  from  leaky 
air  valves.  In  justice  to  this  .system,  how- 
ever, there  is  no  doubt  that  it  works  well, 
gives  satisfaction,  and  could  be  installed 
in  many  heating  })lants  with  profit  to  the 
in.stitution  and  comfort  to  the  occn])ants. 
The  other  type  is  that  in  which  vacuum 
valves  are  placed  on  the  return  or  conden- 
sation ends  of  the  radiators  or  coils,  the 
bottom  of  risers,  and  wherever  it  is  neces- 
sary to  drain  the  supply  mains;  and  the.se 
valves  are  connected  to  the  return  mains 
which,  in  turn  are  connected  to  the  vacuum 
pump.  This  pump  handles  all  the  water 
of  condensation  in  the  system  and  places  a 
vacuum  on  the  whole,  thereby  making  it 
especially  adapted  to  large  in.stallations 
where  otherwi.se  there  would  be  unduly 
large  mains.  This  system  is  of  value  in  the 
remodelling  of  old  steam  heating  plants, 
where,  through  improper  design  or  growth 
by  piecemeal,  the  |)iping  is  too  small,  thus 
necessitating  the  u.se  of  hve  steam  at  a  high 
pressure  to  force  a  circulatioiL  Tnder  such 
conditions  it  can  make  a  good  showing  in 
economy  and  justifies  its  use.  Large  claims 
for  economy  arc  made  for  this  ty|)e  of  sys- 
tem l)ccausc  of  the  vacuum,  but  while  un- 
doubtedly, in  Ihcoiy.  il  ought  to  be  more 
economical  than  low-pressure  steanu  in 
practice  leaky  vaciunn  valves  often  nullify 
all  the  advantages  claimed  for  it.  This 
type  of  .system  is  found  to  be  of  greatest 
value  in  large  installations  where  .steam  is 
neces.sary  for  other  uses  and  where,  there- 


^.r**^''^. 


I 


l^ 


tsl 


roWLI!   I'LANT,  STAMFORD  IIOSIMTAL.  STAMFOKj), 
CONN. 

MP»8RS.   GEORGE   B.    POST   A   SONS,   ARCHITECTS 


12 


m()|)i;k\     II  ()>  i'i  ta  i.s 


Idle,  llic  one  set  of  rii;iiris  cjin  serve  .'ill 
purposes.  Tlie  l;i>l  t'c.iliire  ii.'is  oricii  liccii 
tlie  (iecidiiiii,'  poiiil  in  I'mnoi'  of  wliollv  sleaiii 
sysleius  o\-ei'  oilier  l\|)es  iiiid  lijis  l>eeri  iii;i(le 
imieli  of  eiilii-el\  loo  imicli.  in  llie  wiilei'^ 
opinion. 

Anollier  svslern  wliieli  is  in  i^cnerjil  use 
in  many  hirifv  hospilais  is  the  liol  l)!asl  or 
so-called  IMennni  sxsleni.  'I'liis  consisls  of 
a  series  of  fans  or  Mowei's  rorein<;'  healed 
air  through  duels  of  hriek  or  oalvani/e<l 
iron  inio  Ihe  wards  and  oilier  |)arls  of  liie 
i)nildiiij;s,  the  aii'  heiny'  healed  1»\  coils 
placed  alongside  Ihe  Mower,  oi-  l>y  radia- 
tion at  the  base  of  Ihe  heal  flues.  This  sys- 
tem has  many  advantages  and  has  heen 
more  oenerally  adopted  for  lar^e  instilu- 
tional  work  than  perha|)s  anv  other,  thoiii;ii 
the  cost  of  mainlcnanee  is,  no  donhl,  Ihe 
o'reatesl.  'I'he  ad\anlai;'es  of  this  .system 
are  the  concenlralion  of  Ihe  healiiiii'  a|)pai- 
atus  at  one  point,  Ihe  elimination  of  all 
steam  |>ipini;-  lhroui;houl  Ihe  l)uildin<is,  and 
the  ventilation  or  air  changes  oiven.  Phe 
disadvantaj^es  are  the  cost  of  operation. 
tlu>  power  required  to  drive  the  fans,  and 
that,  if  the  air  is  re-circulated  (as  is  some- 
times done  to  save  expense),  it  then  Inis  no 
advantag-e.s  over  any  direct  system,  Kiil  an 
additional  drawhack  of  the  extra  co>t  of 
operating  Ihe  fan  day  and  night  in  very  cold 
weather. 

In  nearly  all  hospital  hnildings  where 
ventilation  is  actually  re<|uii-ed  Ihe  method 
now  adopted  In  the  most  progressive  engi- 
ueei's  is  to  Iuinc  the  ventilation  svstem  en- 
tirely free  from  iieating;  that  is,  in  tiie  rooms 
and  wards  is  placed  sufficient  direct  radia- 
tion to  take  care  of  the  heat  losses  through 
windows  and  exposed  walls  and  a  certain 
amount  of  aii'  leakage,  flu^  air  for  venlila- 
tion  being  delivered  into  the  rooms  as 
tem|)ered  air  at  about  seventy  degrees  and 
in  such  quantity  as  is  recpiired  l»y  the  nnni- 
l)er  of  occupants  and  the  pnrposi>  for  which 
the  room  is  used,  liy  this  method  the  tem- 
perature of  the  room  can  he  regulated  to 
any  degree  desired,  and  on  pleasant  days, 
when  windows  or  doors  may  he  opened, 
the  fan  introducing  teni])ere(l  air  for  venti- 
lation can  he  stopp(>d  and  cost  of  oj>eration 
saved,  while  snfliciiMit  heat  will  he  main- 
tained hy  the  direct  radiation  to  k<'cp  the 
huilding  comfortahle. 

Another    tyjie   of   heating   which    has    re- 


cently lieen  iiitr-odiH'cd  1)\  a  large  inaiiufac- 
Inring  concern  in  .\c\\  'SOrk  State  is  that 
w  liicli  inserts  lino  of  >lcanj  pipc>  in  the  con- 
>lrnction  under  Ihe  doors  and  lliiis  warms 
the  luonis  In  healing  the  flo(»rs  oid\.  This 
is  (piile  a  daring  depariun-  from  any  of  the 
so-called  "totecl  and  tried""  svslenis,  and 
the  writer  doe-,  not  agree  that  it  could  he 
>iiccess|'nlly  used  in  modern  hospital  prac- 
tice. Il  may  apply  lo  such  buildings  as 
factories,  wheic  the  occupant^  are  on  the 
floors  for  only  a  few  hours  a  da\,  but  I  do 
not  think  a  nurse  or  attendant  coiiM  work 
oil  ^ikIi  a  flnor  the  lioiirs  re(|uirc<l  of  lliem 
in  most  of  our  ho^pitah.  The  liiiih  tem- 
perature lo  which  the  llo(n>  must  be  heated 
ill  order  lo  maintain  an  even  temperature 
in  expox'd  rooms  docs  not  warrant  the 
recommendation  of  this  svstem  for  hospital 
praclic<\  and  it  will  udt.  therefore,  further 
lie  discussed. 

.\  lyp<'  of  lu'ating  system  that  is  gaining 
nincli  favor  in  large  iiislitiitioiis  as  its  ad- 
vantages are  licconiing  better  known  is 
the  hot-water  healing  by  t'orced  circulation. 
Hy  this  is  meant  a  system  of  hot  water  heat- 
ing in  which  a  circniation  is  iniluced  by 
means  of  a  pump  placed  in  the  circuit  of 
the  mains,  (he  water  beino-  heatc(|  \>\  cither 
exhaust  or  liv<'  steam  or  by  both.  The  ad- 
vantages of  this  system  are  economv  in 
steam  coiisnm[)t ioii,  ea.se  of  control.  Ihe 
maintenance  of  a  constant  temperature  in 
the  wards,  and  the  al)ility  to  run  Ihe  mains 
an\  where,  regardless  of  the  grades,  there- 
by making  possible  the  location  of  the  power 
house  at  a  desirable  |>oiut.  which  is  often 
iiol  possible  with  a  wholly  steam  sy.stem 
unless  pumps  or  other  devices  are  installed 
to  return  the  water  of  condensation  to  the 
boilers  or  expensive  pipe  tunnels  are  built. 
Some  of  the  disadvantages  of  this  system 
are  that  it  is  necessary  to  have  an  independ- 
eiil  steam  system,  as  .steam  is  re(|uired  for 
other  purposes  in  nearly  all  hospital  build- 
ings: that  it  re(|nires  a  greater  amount  of 
radiation  than  a  steam  sy.stem  and  a  con- 
se(|uent  greater  cost  of  installation:  that  il 
rt-iiuires  greater  engineering  ability  or 
knowledge  of  design;  and  that  it  nuist  be 
installed  in  a  more  careful  and  better  man- 
ner than  the  usual  type  of  steam  systems. 
One  of  the  great  advantages  and  one  that 
should  not  be  o\'ei'looke<l,  is  the  abilitv  to 
control    the    temperature    in    the    buildings 


13 


MODERN      HOSPITALS 


bv  controlling  the  temperature  of  the  water 
and  the  flow  at  the  power  liouse,  besides 
the  individual  control  of  the  radiators  or 
coils.  That  this  means  much  will  be  con- 
ceded when  we  consider  the  great  varia- 
tion in  temperatures  to  which  we  wlio  live 
in  the  east  are  subjected.  In  the  New 
England  States,  for  example,  the  tempera- 
ture varies  during  the  heating  season  from 
zero  to  fifty  degrees,  and  even  more.  As 
sufficient  radiation  must  be  installed  to  heat 
the  rooms  to  seventy  degrees  in  zero  weather, 
and  as  the  average  temjjerature  for  the  heat- 
ing season  in  New  England  is  a])j)roxi- 
matelv  thirty-five  degrees,  with  a  steam 
system  of  100  per  cent,  more  steam  is  used 
for  heating  than  is  actually  required.  If 
projier  attention  could  l)e  given  and  the 
radiation  shut  off  when  the  temperature 
gets  above  seventy  degrees,  this  would  not 
occur,  but,  unfortunately,  this  is  not  pos- 
sible where  there  are  a  great  many  radia- 
tors or  coils  and,  besides  it  is  much  easier 
to  open  a  window  and  let  the  surplus  heat 
escape.  In  some  of  the  better  class  of 
hospital  buildings,  thermostatic  valves  are 
installed  on  the  heat  sources,  which  regu- 
late the  temperature  of  the  building  In' 
control  of  the  supply  of  steam  to  the 
radiation.  Such  devices  are  not  only  an  ex- 
pense to  install.  l)ut  are  often  found  troul)le- 
some  to  maintain.  Their  installation  the 
writer  would  recommend  only  to  the  better 
class  of  buildings  and  large  wards  and  clinics 
where  hrst  cost  is  not  to  be  considered. 
It  may  be  claimed  that  it  is  possil)le  to  ol)- 
tain  a  degree  of  regulation  with  steam  by 
varying  the  pressure,  but,  even  so,  the  best 
that  can  be  obtained  by  such  a  method 
is  by  the  use  of  high  pressure  steam  direct 
from  the  boilers,  which  is  not  good  practice. 

A  hot  water  system  is  especially  adapted 
to  the  heating  of  many  widely  separated 
buildings.  Where  ventilation  or  rapid  air 
changes  are  required,  fans  supplying  fresli 
air  or  exhausting  vitiated  air  are  driven  bv 
electric  motors.  "^IMie  hot  water  for  all 
domestic  purpo.ses,  also  for  tlie  heating 
system,  is  heated  at  the  central  plant  and  all 
apparatus  centralized   in   the  power  house. 

In  sutiiiniMg  up  the  ditt'erent  systems 
above  described,  as  applicable  to  modern 
hospital  practice,  many,  no  doubt,  will 
ask  the  (luestion,  "Which  is  the  best  of 
the     several     recommended.^"       You     will 


agree  with  me,  I  think,  when  I  say  that  it 
is  seldom,  if  ever,  that  a  patient  is  admitted 
to  our  hospitals  and  treated  by  our  physi- 
cians or  surgeons  without  a  very  care- 
ful study  or  diagnosis  of  the  case.  The 
treatment  that  would  apply  to  one  j)robably 
would  not  apply  to  another.  Just  so  in  the 
question  of  modern  heating  and  ventilat- 
ing systems.  A  study  of  all  conditions 
must  be  made  and  if  a  competent  and  re- 
liable engineer  be  consulted,  he  will  value 
his  reputation  as  much  as  the  physician 
and  siu'geon.  and  will  design  a  system 
best  adapted  to  the  needs  and  locality  of 
the  institution. 

A  recent  design  for  a  large  system  of 
hospital  heating  and  ventilating  in  the 
Dominion  of  Canada  where  extreme  tem- 
j)eratures  had  to  be  considered  might  be 
referred  to.  After  months  of  very  careful 
study  a  combination  system  was  adopted; 
namely,  a  forced  hot  water  system  for  all 
direct  heating  and  a  steam  system  for  all 
tempering  coils.  Practically  every  room 
in  the  group  of  a  dozen  or  more  build- 
ings is  to  be  warmed  by  direct  radiation. 
Tempered  air  will  be  introduced  to  all  large 
wards  and  operating  rooms  and  such  other 
rooms  as  require  rapid  air  changes.  The 
ventilation  will  l)e  entirely  independent  of 
the  heating  system  and  will  be  largely  by 
exhaust  fans  on  the  roofs  controlled  by  elec- 
tric motors. 

The  writer  thoroughly  l)elieves  in  natural 
ventilation  as  far  as  possible.  There  are 
but  very  few  days  during  the  heating  season 
that  the  well-trained  nurse  will  not  have 
the  windows  partly  oj)en  to  admit  the  health- 
giving  fresh  air  just  as  it  is  provided  by 
the  Creator.  At  such  times,  the  direct  hot 
water  heat  will  probably  care  for  the  tem- 
j)erature  of  the  rooms  and  the  tempered  air 
will  not  be  recjuired.  Therefore,  the  fans 
introducing  this  air  can  be  shut  down  and 
the  ex])ense  of  operation  saved. 

I  have  often  found  entire  systems  where 
the  wards  were  wholly  dependent  upon  the 
introduction  of  air  by  fans  or  under  pres- 
sure, where,  owing  to  the  great  ex|)ense  of 
operation,  the  same  are  not  used  or  only 
partly  .so,  and,  therefore,  no  air  is  admitted 
to  the  rooms  if  doors  and  windows  are  closed, 
except  what  enters  by  wall  or  window 
leakage.  In  designing  the  I'lenum  cham- 
bers and  ducl.s,  in  this  instance,  they  are  so 


14 


\l()l)Kir\       II  OSI' J   I  A  I.S 


arraiif^t'd  as  lo  iiiltodiicc  cdiisLhiIK  Iciii 
pered  air  l>\  i;ra\il\,  simnld  die  I'aris  lie 
dosed;  also.  Ilic  syslcin  of  vciilNalioii  will 
!)(•  ()|)<'ii  upon  the  same  f^cncral  plan  li\  IIh' 
iiitrodiiclioii  of  a.spiraliii<f  coils  citlicr  in  llic 
flues  dieinselves  or  at  Hie  point  of  assend)l\ 
on  the  roof.  In  tliis  way.  1  maintain  llial 
while  we  shall  Ke  aMe  conslanilv  lo  care  fur 
our  room  tempei'atnres  \>\  dir'ccl  ladiation, 
we  shall  also  liave  a  natural  j,n-avity  ven- 
tihdinji'  system  that  will  "-ive  us  from  two  lo 
tliree  changes  ot'  air  [)er  hour,  even  lhoni;li 
tiie  exluiust  tans  l)e  closed  down,  'riiere  arc 
manv    interestiufj;   |)hases   of   this   condiina- 


lion  liol  water  and  ^Icam  i\  .^leni  thai  1 
^lioulil  like  \cr\  mmh  lo  discuss  if  the  time 
pcrmittcfi.  I  will  oidy  add.  Iiowever.  that 
as  far  as  1  have  liecri  aiilc  lo  learn,  tliis  is  the 
first  conihiuation  hot  \\alcr  and  steam  .sys- 
tem of  this  nature  applied  lo  iio^pital  pra<-- 
tice  and.  no  donlil,  will  In-  watched  with  a 
f^reat  ileal  of  inlercsl.  I  lliorou<,dily  l»e- 
lie\'e  lli;il  foi-  ;i  larj^ely  scaltcicd  iii-litution 
located  Ml  a  lold  section  ol  llic  cdimlrs. 
what  i^  now  licmn  |il;iiiiic(|  inr  llii~  iiimlci-n 
hospital  will  pro\c  the  simplest,  most  eco- 
nomii-al  .ind  -atisfactoiA  of  all  systems, 
in   U-.C  in   niodrrii  ]  iraclicc. 


w  \i;ii  i\  >i  la.n  Ai.  lu  ii.DiNc.  \i  \i,  \i:  \  iai.i  s  Mi:\i()i;i  \i.  m  )-i'i  r\i, 

MKssiis.  i;ni.i;\  .^   «  r<  Ks.    Mii  ill TKcrs 


15 


THE  BARNARD  SKIN  AND  CANCER  HOSPITAL 

MAURAX  &  RUSSELL,  ARCHITECTS 


HIS  l)uilding  is  Hreproof 
throughout  with  an  ex- 
terior of  I)riek  and  terra- 
eotta.  while  the  interior 
is  uniformly  of  reinforced 
(•  o  n  (•  r  e  t  e  construction 
^  .       with  a  finish  on  all  walls 

I  j       and      ceilings,      cohunns. 

'--  -^  etc.,  of  Acme  hard   |)las- 

ter,  painted  with  impervi- 
ous enamel  i)aint.  While  the  floors  through- 
out, together  with  the  leases,  are  of  carholith 
without  joints  of 
any  sort,  it  is 
hardly  necessary 
to  say  that  all 
modern  hospital 
require  ments 
were  observed, 
such  as  rounding 
of  all  interior  and 
extericn-  angles, 
including  the  car- 
bolith  base,  with 
particular  provis- 
ion on  all  com- 
municating doors 
against  tlie  neccs- 
sity  ot  openmg  hy 
hand  and  the 
similar  provision 
against  hand  op- 
eration in  the 
p  1  um  l)in  g  fix- 
tures. Nothing 
has  been  omitted 
looking  to  a  thor- 
oughly a  s  e  p  t  i  c 
construction  f  o  !■ 
the     particular 

needs  of  this  kind  of  a  hospital. 
The  uni(|iie  features  to  which  we  woul<l 
call  particular  attention  arc:  There  arc- 
two  gateways  to  the  hospital,  the  main 
entrance  for  the  admission  of  doctors,  staff, 
nurses  and  the  public  and  the  clinic  entrance, 
which  also  serves  a.s  the  cntiauce  for  pa- 
tients. No  access  is  had  fioin  tlic  entrance 
for  supplies  in  the  rear  or  through  the  special 


MKZZA.NLNK  AM)  l!(K)l'  I'lAN 


exit   provided   for   the   removal   of   the   ca- 
davers. 

Briefly,  the  course  of  a  tyj)ical  case 
ap|)lying  at  the  ho.spital  is  as  follows: — 
Through  the  clinic  entrance  viu  the  exami- 
nation rooms  the  ai)|)licant  is  taken  directly 
to  the  hydrotherapy  which  is  directly  under 
the  clinic  and  absolutely  shut  off  from  the 
hospital  ]iro]>er.  After  thorough  l)athing 
and  cleaTisiny;,  the  clothes  havin"'  been 
removetl  to  the  sterilizer  in  the  l)oiler  room, 
the  patient  is  taken  in  hospital  garb  to  one 

of  the  rooms  on 
the  main  floor  in 
the  wing  to  the 
north  sijecihcally 
reserved  for  ob- 
noxious c  a  s  e  s  . 
This  isolated  sec- 
tion is,  in  fact,  a 
hos])ital  by  itself 
in  so  far  as  com- 
munication, food, 
.service,  pluml)ing 
a  n  d  ventilating 
are  concerned. 
As  objectionable 
.sym})toms  a  r  e 
ameliorated,  the 
|)rogress  is  to  one 
of  the  j)rivate 
rooms  on  one  of 
the  upper  floors 
and  as  improve- 
ment continues, 
eventually  to  the 
ward. 

It  will  i)c  noted 

that    till'    (ih.'io/iifc 

shutting      off     of 

means    of 


one    floor    from    another 
enclosed    clcvatoi'    shaft 


by 
anc 


ic 


tlie  enclosure 
of  the  stairway  in  a  metal  and  |)olished 
wire  glass  enclosure,  gives  as  thorough  sep- 
aration as  would  separate  l>nildings  with 
connecting   links. 

The  laboralorv  facilities  are  unusually 
coniniodious  and  eom|)lcte.  as  this  hospital 
devotes  an  uiuisual  amount  of  attention   to 


16 


\l  ()  I)  !•;  K  .\       ll()>l'  I   I  A  I.S 


the  slii(I\  ;is  well  .is  llic  .iiiicliDiMlidii  n\' 
llic  (liscjiscs  Irciilcil. 

Tlic  ()|KM';il iiiu,'  rooms  li;i\c  lln'  iiiiii|iic 
I'ejiliirc  of  |)('riiiilliiii;  IIh'  sIikIciiIs  |o  oIi- 
sci'vc  ()|)ci';i I loiis  IVoiii  ;i  (diiiiiioilioiis  riic/- 
/.iiiiiiic  (looi-  w  lllioiil  III!'  il.-iii^cf  of  iiil'ci-lioii. 
wliicli  is  oiijinlcd  a^jiiiisl  li\  inrjuis  of  ;i 
phite  "iliiss  screen. 

'riie  whole  efl'eel  ;iii(l  resiill  in  ihc  Use 
ol'  tlie  h(>s|)it;il  (hiriiii;'  Ihe  hisl  six  inonllis 
is  of  ;i  ln'in'hl,  .illijielivc  iiiid  ihoroii^hly 
seieiilihe  iirraii^eiiiciil  eoNciiiii;'  Ihc  |);ii- 
lieiihir  needs  of  .-i  skin  and  c;iin'cr  hos- 
pital. 


T 


TlIK    MODKRX    IIOHI'II  \l, 

UK  staienieiit  has  heen  made  that  Ihc 
Ijuildinj;'  of  hospitals  is  a  |)i'aclieal 
expression  of  man's  .sen.se  of  res|)onsi- 
bilitv  for  the  physical  well-lteiiii;'  of  his  fellow 
creatures.  If  we  accept  this  (h-iinilion, 
the  work  .shonld  command  our  sympa- 
thies, as  well  as  our  most  |)rofound  sludy. 
IVrhaps  there  is  no  class  of  linildini;s  that 
demands  .so  thorough  an  nn(h'rstandini^. 
on  the  part  of  the  architect,  of  the  various 
uses  to  which  the  ditfen-ut  rooms  and  de- 
partments of  a  l)uilding-  are  lo  he  put.  ,is 
does  that  to  which  iios|)ilals  heloug-.  In 
oi'der  to  design  and  e(pii|)  a  hospital  huild- 
ing  in  a  nianner  that  will  render  it  of  great- 
est value  to  the  counnunity  in  which  i!  is 
erected,  an  architect  must  eond)ine  uilh 
the  ability  of  an  artistic  designer,  a  knowl- 
ed<>'e  not  oulv  of  sanitation,  heatini;-,  ven- 
tilation  and  the  various  structural  reiiun-e- 
ments  of  the  average  building,  but  al.so  a 
considerable  degree  of  familiarity  with  the 
nraetiee  of  meilicine  and  surgery.  lie  must 
by  reading  and  study  keep  al>i-east  wilh  Ihc 
progress  made  in  the  care  and  trt-almeni 
of  the  sick  and  di.sea.sed,  as  well  as  that 
made  in  Ihe  science  of  building. 

The  im|)ortance  of  a  full  understanding 
of  the  essentials  in  hos|)ital  design  is  real- 
ized when  we  consider  that  if  an  error  occurs 
due  to  an  imperfect  knowledge  of  acoustics 
the  architect  of  a  tlieatre  or  hall  lias  ,il 
wor.st  .sim|il\  failed  to  secure  for  his  c|i(>nl 
the  maxinuini  of  satisfaction  in  oper.ilion 
and  hence  revenue  obtainal)le  from  his 
investment.  The  same  might  be  said  in 
the    ease    of    failure     to     provide    ade(|uale 


lacililics  for  th*'  siieeessfnl  operation  of  a 
<onimercial  building.  Moicover,  these  rle- 
lects  would  lie  oluious  and  jirobablv  read- 
ily remcflicd.  bul  in  Ihe  r'ase  of  an  improp- 
<'ily  \cnliialed  Jiospital  or  one  not  j)ro\  ided 
\\ilh  projjcr  jind  adcijn.ale  .sanitary  ecjuif)- 
nienl,  Ihe  lack  while  perhaps  unappareni 
woidd  ne\ filhelcss  endanger  if  it  did  not 
•  ■aiisc  Ihc  p(i-ilive  sacrifice  of  hiim.-in  life. 
In  \  iew  Iherclore  of  Ihe  complex  nature 
which  cliaiacteri/.es  hospital  planning,  and 
Ihc  sciidUs  r<'sulls  wIikIi  mmi-I  in  ;i  njeasiire 
.il  least  follow  any  failure  to  full\-  realize 
and  amply  pi'ovide  for  the  \arious  re(|uire- 
menls,  il  would  seem  lo  be  a  ilutv  which 
the  incmliei's  of  the  profession  owe  humaii- 
ily  to  thoroughly  acfpiaint  tliemselves  with 
Ihe  probIem.s  presented,  .■in<l  the  .soliition.s 
already  furnished  before  atlcmpting  to  meet 
the    needs  of  any    j)aiticular   situaticju. 


\'\(i  iM  ('i.i;\\i\(,  SvsTKMs    \   Di;«ii{AHi,K 

I"'l..VlL  Kl,    1\     -MuDl.liN     11(J.->I'ITAL.S 

Till-",  |)r<'\ailing  idea  now  among  the 
leading  hospital  authorities  is  that 
every  hospital  of  fifty  beds  or  over, 
w  here  power  is  a\  ailable,  .should  l)e  j)rovided 
with  a  vacuum  cleaning  plant.  The  original 
piping  call  l)e  very  sim|)ly  done  and  .should 
have  a  snfhcient  number  of  outlets  to  make 
the  work  easily  aeeomplislie(|  by  the  attend- 
ants. Kaeli  outlet  should  i)e  valved  so  that 
the  ap|)lying  of  Ihc  hose  wduld  lie  done 
with  as  lillli'  noise  as  possiiile  so  as  to  avoid 
disturbing  the  patients  when  this  work  i.s 
going  on. 

The  chief  advantage  of  the  vacuum 
cleaning  system  is  that  all  dust  and  dirt 
arc  taken  diieclly  to  the  receiver  without 
disturliing  or  distriiinting  the  particles  of 
dust  or  bai-teria.  which  are  always  a  menace 
where  the  floor  is  swept  in  the  ordinary  wav. 
For  that  reason,  the  portable  vacuum 
cleaner,  which  exhausts  into  the  air  of 
the  room,  should  lie  avoided  in  hospital 
rooms  unless  this  exhaust  is  conducteti  into 
Ihe  open  air  by  a  .second  flexible  |)ipe. 
The  refuse  from  the  cleaner  should.  <»f 
course.  Ih>  luirned  and  not  liberated  into 
Ihc  open  .lir.  ("are  should  be  taken  lo 
procure  as  noiseless  a  |)lant  as  possible 
for  tlie  hosjiital  l)uildiiigs.  -£'.  F.  Stevens 


r 


^r  O  D  E  R  X      H  O  S  P  IT  A  I.  S 


The  New  Gexkkal  Hosphal,  ri\<'iNN'ATi, 
Ohio 


M 


3lessrs.  >anuie 


Hannaforil   &  Sons,   Architects 


THE  typical  ward  building  illustrated  has 
its  long  axis  directly  north  and  south. 
The  basement  has  ceiling  10  feet  high 
the  rooms  are  from  two  to  four  feet  out  of 
ground  accortling  to  the  slope  of  the  land. 
Above  the  basement  are  the  three  stories 
or  ward  units  and  over  the  double  corridor 
portion  or  "head-house"  of  the  building  is 
a  fourth  floor  containing  a  smaller  ward 
and  accessory  room  from  which  is  reached 
an  o|3en  roof  garden,  100  feet  long.  This 
roof  garden  is  surrounded  by  a  jjarapet 
about  nine  feet  high,  pierced  by  screened, 
low-set  windows.  The  basement  of  all  the 
buildings  are  connected  at  the  north  end  l)y 
well-lighted  basement  corridors,  the  average 
being  ten  feet  high  by  ten  feet  wide. 

The  ward  units  as  shown  in  the  plan  of 
the  first  floor  present  the  following  features: 
To  the  right  of  the  door,  entering  the 
central  corridor  from  the  ])orch  is  a  s|)ace 
comnuinicating  with  the  doors  and  ele- 
vator. This  is  the  "Fresh-Air  Cut  Off" 
and  measures  seven  by  nineteen  feet.  This 
|)revents  the  air  from  the  basement  and 
from  the  otlier  stories  entering  into  direct 
communication  witli  the  ward.  The  fresh 
air  enters  from  the  door  or  transom  and  is 
exhausted  through  the  ventilating  shaft 
near  the  elevator.  'I'he  "Fresh-Air  Cut 
Oft""  also  permits  the  complete  isolation 
of  the  first  floor  from  those  above.  The 
central  corridor  is  eight  feet  wide  and  sixty- 
seven  feet  long  and  is  lighted  by  large  glass 
panel  doors  and  transoms  at  lioth  ends. 
A  sanitary  driid<ing  foiuitain  is  j)!aced  in 
the  corridor  near  the  visitors'  bench.  The 
serving  room  or  diet  kitchen  is  thirteen  by 
fifteen;  the  food  coming  from  the  central 
kitchen  enters  this  room  through  the  pas.s- 
door  and  is  here  divided  and,  if  necessary, 
reheated.  Tiie  dining-room  for  convales- 
cent patients,  fourteen  feet  nine  inches  by 
fifteen  feet  nine  inches,  can  also  be  used 
as  a  day-room  should  the  overcrowding  of 
the  ward  demand  the  use  of  the  ward  solar- 
ium for  Ix-dridden  patients.  The  bathroom 
is  nine  feet  six  inches  by  fifteen  feet  nine 
inches.  There  is  a  .shower  on  the  male  side 
only,  experience  having  shown  that  women 
will  not  willingly  take  shower  baths.     This 


bathroom  has  both  |>ortalile  and  stationai'V 
tubs.     In  the  children's  room,  the  tubs  are 
omitted     and    showers,     slai)s    and     sprays 
take  their  place.      In  order  that  the  nurses 
may  attend  to  tlieir  duties  in  the  sink  room 
and  yet  have  all   the  convalescent   patients 
under  observation,  wlut  are  al)le  to  use  the 
bath  room,  a  plate  glass  four  by  sixteen  has 
been    placed   in    the   partition    l)et\veen    the 
bath   and   sink   room.     The  siidv   room  has 
the    custonutry    e(juipment    for    sterilizing, 
etc.      Leading   from    the   sink    room    is   the 
nurses'  work-room,  which  is  eight  feet  l)y 
six  feet  nine  inches.     This  room  .serves  the 
double  purpo.se  of  a   "Fresh-Air  Cut  Off" 
between    the   ward    and    sink    rooms.     The 
work-room   is  connected   with   the  ward  by 
an  open  arch,  so  that  the  nurse  can,  even  if 
at  work,  see  the  flash  signal  at  her  desk  at 
the  entrance  of  the  corridor.     On  the  left 
of  the  corridor  and  beginning  at  the  main 
entrance  from  the  ])orch,  a  room  for  treat- 
ment and  class-room  purpo.ses,  twelve  feet 
six  inches  by  fifteen  feet,  has  been  planned. 
The  door  leading  to  this  room  is  extra  wide, 
so  as   to   permit   the   ])atients   being  trans- 
ferred to  this  room  in  their  beds  when  it  is 
necessary. 

Hos])ital  practice  in  this  country  and 
abroad  has  demonstrated  the  neces.sity  for 
more  small  rooms  in  connection  with  the 
large  wards,  where  special  cases  mostly  of 
an  obnoxious  type  can  be  taken.  F'or  this 
reason  there  have  been  ])laced  in  these  pa- 
vilions one  two-bed  and  three  single-bed 
rooms.  In  order  that  the  various  kinds  of 
service  may  have  rooms  of  adecjuate  size 
for  treatment  and  lecture  rooms  adapted 
to  their  special  needs,  it  has  been  so  planned 
that  the  partition  l)etween  the  treatment 
room  and  the  two-bed  ward,  which  is  eleven 
feet  by  sixteen  feet  nine  inches,  can  l)e 
moved,  thus  enlarging  the  lecture  and  treat- 
ment room  and  reducing  the  doul)le  room 
to  a  one-bed  room,  ^^he  doors,  leading  into 
each  of  the  small  rooms,  will  iiave  a  peep- 
hole covered  with  a  movable  metal  plate, 
.so  that  the  nurses  passing  down  the  hall 
can  inspect  tlie  I'oom  without  disturbing 
the  patient. 

'^rhe  architects  believe  that  it  woidd  be 
extremely  wise  now  to  plan  liberally  enough 
to  provide  for  future  development  and 
therefore  additional  small  rooms  have  been 
planned   for  carrying  out   new   methiKis  of 


18 


MOD  K  K  \       II  OS  P  I   r.\  I,S 


trealiiiciil  tli.'il  inc  mii'c  Io  (Ic\c|(i|)  hi  IIic 
futur(>.  Tlic  inside  incjisurciiiciils  of  llic 
wan!  arc  iiiiK-ty  in  tliirtv  In  lliiticcii  led. 
It  contains  twenty-Fonr  Weds,  i^ivin^  W^H 
scuiarc  I'cot  of  floor  space  and  \AUi  cnl)ic 
feet  ot   air'  space  for'  eacli   Ix-d.      Macli    l)cd 


^l.•lnd^  hctwccn  two  window-,  which  extend 
III  liie  ceilin;^^  'Ihe  heating-  is  \>y  means 
of  ImiI  walci-  |)i|)c^  and  liy  indirect  niethofj. 
I'hc  olhcr  details  of  the  waid  Imilding  may 
Ik'  I'cadiiy  delcfnn'ned  IVom  tli<-  [il.-ni->  that 
arc   pnlilishcd    herewith. 


STAMFORD  HOSPITAL,  STAMI'OKD,  COW. 

MESSRS.  GEORGE  I!.   POST  A  SONS.   ARCHITECTS 


SOME    ESSENTIALS    OF    HOSPITAL    HEATING 

AND    VENTILATION 

Bn  I).  D.  KIMBALL 


V  is  noteworthy  that  the 
many  years  of  hospital 
construction  in  this  coun- 
try have  entirely  failed 
to  produce  an  accepted 
standard  or  method  of 
hospital  heating  and  ven- 
tilation. This  is  not  so 
strange  as  it  may  seem 
if  consideration  he  given 
to  the  almost  infinite  variety  of  physical 
conditions  and  needs  of  hospital  patients 
and  of  the  nature  of  the  buiUlings  and  tlieir 
surroundings.  Manifestly  a  method  of 
treatment  for  a  hospital  for  the  ruptured 
and  crippled  who,  in  a  general  sense  are 
not  ill,  is  not  suitable  for  a  hospital  for 
contagious  diseases  or  for  a  surgical  ward. 
Nor  is  the  method  suitable  for  a  hos})ital 
in  the  open  country  adaptable  to  a  hospital 


built  within  city  limits,  particularly  if 
the  city  in  question  be  one  with  an  atmo- 
sphere like  that  of  Pittsburgh. 

There  is  still  a  wide  difference  of  opin- 
ion as  to  the  merits  of  artificial  ventilation 
as  applied  to  hospitals.  A  ])rominent  hos- 
pital expert  recently  made  the  statement 
that  there  was  no  such  thing  as  a  ventilat- 
ing system  for  hospitals,  that  clinical  rec- 
ords in  one  of  tlie  largest  hospitals  of  New 
York  City  proved  that  the  l)est  results  were 
olitained  in  the  wards  in  whicli  no  artificial 
ventilating  system  was  used,  free  use  being 
made  of  the  windows.  The  statement  was 
also  made  that  the  air  was  "roasted" 
in  passing  through  the  heaters  to  a  tem- 
j)erature  of  400  degrees,  the  absurdity  of 
which  statcTiient  ])ecomes  apparent  when 
it  is  recalled  that  the  temperature  of  the 
steam  used  for  heating  rarely  exceeds  Ho 


19 


MODERN      HOSPITALS 


degrees,  while  to  reach  a  temperature  of 
400  degrees  a  steam  pressure  of  over  ;>00 
pounds  per  square  inch  would  be  recjuired. 
Investigation  led  the  writer  to  the  conclu- 
sion that  the  o])inion  expressed  was  based 
upon  an  experience  with  an  antiquated, 
inefficient  and  insufficient  system  of  ven- 
tilation. The  windows,  in  some  cases, 
were  not  only  shut  at  all  times,  but  screwed 
fast  or  locked,  the  key  in  the  latter  case, 
l)eing  in  the  hands  of  the  Superintendent. 

Recently  a  hospital  building  has  been 
built  without  a  system  of  artificial  ventila- 
tion, entire  dependence  for  ventilation  be- 
ing placed  upon  the  windows.  An  unfor- 
tunate experience  may  safely  be  predicted 
for  this  building. 

It  is  granted  that  luider  many  conditions 
no  better  ventilation  may  be  had  than  nat- 
ural ventilation  through  |)roperly  construct- 
ed windows,  a  fact  too  little  appreciated 
bv    many   designing   heating   and   ventilat- 


ino-  enguieers 


But  there  are  many  condi- 
tions within  the  wards  under  which   it  is 
(lesiral)le  to  close  the  windows,  many  days 
when  inclement  weather  makes 
openino-    of    the    windows    un 


desirable  or  impossible,  and 
many  more  days  when,  be- 
cause of  the  direction  of  the 
wind,  absence  thereof,  or  be- 
cause of  a  sultry  atmosphere, 
no  ventilation  may  be  had 
through  the  windows. 

Artificial  ventilation,  as  an 
adjunct  to  natural  ventilation, 
is  an  absolute  necessity  if  the 
best  results  arc  desired,  as 
is  well  evidenced  by  the  in- 
creased mimbers  of  cures  am 
lessened  time  required  for 
recovery  in  ventilated  hospitals. 

Actual  exam- 
[)les  or  proofs  of 
the  value  of 
hospital  venti- 
I  a  t  i  ()  II  are 
coni|)ai'al  i  v  e  ly 
rare  because  of 
the  difficulty  of 
obtaining  lil<c 
conditions 


lor 

c  o  tri  p  a  r  i  s  on, 
lime       element, 


SKCOM)    AND     IIIIKI)    Fl.OOliS,    ADM  INISIUA'IION    IUTII.I) 
ING,  STAMI'Oiil)  IIOSI'ITAI.,  STAMI'Olil),  CONN. 


etc.,  but   in  school  and  commercial  circles 
illustrations  are  aljiuidaiit. 

In  no  place  is  thorough  ventilation  so 
truly  a  requisite  as  in  hospitals.  Shocks 
due  to  accidents  or  a  collapse  sometimes 
attending  siu'gical  operations  reduce  the 
vitality  and  render  the  patient  unusually 
suscej)tible  to  improper  surroundings.  The 
vital  resistance  is  diminished,  or  in  some 
cases  a|)parently  lost,  by  disease,  making 
necessary  the  most  helpful  of  surrounding 
conditions.  The  patient  is  acutely  sus- 
ceptible to  the  effect  of  imj)roper  hygienic 
surroundings.  Pure  air,  proper  medicine, 
the  best  of  food  and  skilled  attendants  are 
of  equal  importance. 

The  reports  of  the  Boston  City  Hospital 
show  that  improved  general  sanitary  condi- 
tions in  that  institution  changed  the  death 
rate  from  forty-four  per  cent,  to  thirteen  per 
cent.  In  the  general  wards  of  the  same 
hospital  the  sanitary  improvements  effected 
changed  the  death  rate  from  twenty-three 
to  six  per  cent.,  or  nearly  in  the  same  ratio 
as  in  the  surgical  wards. 

At  the  S.  R.  Smith  Infirmary 
at  Staten  Island  a  comparison 
was  made  in  two  wards  of 
tlie  same  nature  containing  the 
same  class  of  patients,  in  which 
case  it  was  found  that  in  the 
ward  without  ventilation  an 
average  of  sixteen  days  was 
required  to  effect  a  cure,  while 
in  the  ventilated  ward  the 
average  was  ten  days.  This 
also  means  a  greater  work 
with   the   same  equipment. 

In  the  Dublin  Lying-in  Hos- 
pital the  death  rate  under  old 
conditions  reached  50  per  cent, 
of    those    born,    while    for    an 
e  (]  u  a  I    period 
with      imjiroved 
sanitary        con- 
ditions,    includ- 
ing    vcniilation, 
drainage,    light- 
ing   and     disin- 
fection,       t   h   c 
death     rate     fell 
to  five  per  cent, 
("criaiii     it     is 
tiiat  the  hospilal 


^0 


M  Ol)  K  K  N       II  OS  !■  riA  I.S 


pulicMit  wilii  liis  wcakciu'd  vilalil)  sliuuld  he 
provided  with  the  best  possible  siirromidiiii; 
coiidilioiis.  l*A('r\'  possiMe  care  is  exer- 
cised in  sciecliiij;'  llie  palieiit's  food  and 
drink.  Inasmuch  as  llic  ainoiml  of  aii- 
a  normally  lu>altliy  person  hrealhes  is  ;5.0()() 
limes  hy  volume  and  Iwenty-live  times  liy 
weiii'ht,  the  drv  iood  eaten,  should  iiol  llic 
<;reatest  |)ossil)le  care  he  exei'cised  m  pro- 
viding suilahle  air  lor  hreathing.^ 
It  is  probable  that  in  the  past 
loo  little  consideralion  has  been 
given  to  the  conditioning  o 
the  air  provided  by  the  venti- 
lating system,  v.r.,  the  regida- 
tion  of  its  dust  content,  tem- 
perature and  humidity,  factors 
now  regarded  as  ((uite  as  im- 
portant as  air  (piautity. 

A  certain  New  York  hospital 
board  was  led  to  condemn  arti- 
licial  ventilation  because  of  the 
results  with  the  system  used 
in  their  large  downtown  branch. 
Investigation  disclosed  that  the 
air  intake  of  the  ventilating 
s  y  s  t  e  m  w  a  s 
through  an  area 
at  the  sidewalk 
level  on  one  of 
the  busiest  tho- 
roughfares in  the 
city,  no  means  of 
tiltering  the  air 
were  provi<led, 
humidifica  I  ion 
was  absohilcly 
nealected,  n  o  I'MiST 
system  of  tem- 
perature regula- 
tion was  installed,  and  the  size  of  the  duels 
and  location  of  registers  indicated  that  the 
volume  of  air  had  been  too  small,  its  tem- 
perature too  high  and  its  diffusion  nil.  The 
heating  ap])aratus  was  crowded  into  a  space 
altogether  too  small,  thus  permitting  of  no 
additions  or  improvements.  And  be  it  noted 
that  cram])ed  sjiaces  and  failures  of  venti- 
lating systems  are  intimately  related.  A 
cloud  of  dangerous  dust  reached  the  rooms 
with  the  operation  of  the  sy.stem  rather  than 
a  stream  of  revivifying  air.  Small  wonder, 
therefore,  that  the  system  was  condemned.  It 
is  unfortunate,  however,  that  such  samples 
of   artificial    ventilating   systems   should    be 


II.OOH,    AD.MINISTRAIION    HUILDIXG 
IIOSPITAI.,  STA-UKOIil),  COXX. 


'|ii'|lc(|    a^    <ili|cclii)ji>    lo    the    iii.^tallation    of 
modern  and  cllicient  .systems. 

'I'lic  first  esseidial  of  hospital  vciililation 
is  ample  provision  for  natural  vcntilaticjii, 
Ihal  is.  pl(iil\  of  window  ojjenings  with 
properly  arranged  windows.  An  arrange- 
iiicnl  of  the  windows  frecjueiitly  advo- 
<alc(i  by  li()s|iil,d  (experts  is  the  casement 
window  opening  out  in  halves,  half  of  the 
w  iiidow  to  be  thrown  out  lo  catch 
the  wind  depending  upon  direc- 
tion thereof,  a  lop  light  or 
transom  swinging  in,  being 
placed  above  for  night  u.se, 
all  of  which  is  good,  but  the 
use  of  this  requires  constant 
attention  on  the  part  of  the 
nurses.  Of  itself  il  is  not  a 
ventilating  system.  A  substi- 
tute for  the  above  window  is 
the  ordinary  doiible-hung  win- 
dow with  a  plate  glass  .shield 
at  the  bottom  of  the  window 
inside,  tipping  in  at  an  angle  to 
defied  llie  air  upward  when 
.sash  of  the  win- 
dow is  raised. 
Open  air  bal- 
c  o  n  i  e  s  m  a  y 
hardly  be  con- 
sidered as  a  [)art 
of,  or  es.sential 
to,  a  ventilating 
system.  t)ut  they 
are  don  lit  less 
e.ssentia!  In  the 
equipment  of 
a  modern  hospi- 
tal, some  experts 
maintainingthat 
)f  llie  floor  area   of 


STAMI  OKI) 


lea  si 


lifl\ 


_)('!■   cent.  II 
a   hosjtital   should   be  out  of  doors. 

(^uile  as  importani  as  this  [provision  for 
naluial  ventilation  is  the  provision  of  a 
system  for  the  ])ositive  supply  of  fresh  air 
when  the  natural  supply  must  be  .shut  nf\' 
or  is  not  dependal)le.  This  may  take  the 
form  of  a  fan  system,  and  usually  should 
for  a  large  i)uilding  or  a  building  within  a 
city,  or  it  may  consist  of  a  gravity  system 
in  the  ca.se  of  a  small  building,  the  latter 
lacking  the  advantages  of  ])ositiveness  and 
the  difficulty  of  applying  filters  or  satis- 
factory humidifying  devices  thereto. 

Essential  to  the  full  success  of  either  the 


■21 


MODERN      HOSPITALS 


AU.MlNlSTK.VnON'  AND  WARD  BUILDINGS,  S  IWMFOilD  HOSPITAL.  STAMFORD,  CONN. 

MESSR.S.    nEOR(;F;    n.    P0.ST    *    .sons,    .VRCHITEfTS 


natural  (window)  or  artificial  ventilating 
system  is  a  system  for  exhausting  the  viti- 
ated or  foul  air.  This,  too,  may  take  the 
form  of  either  a  gravity  or  fan  system,  the 
latter  .system  being  prefer- 
able because  of  its  positive- 
n  e  s  s  and  independence 
of  varying  weather  conditions. 
The  amount  of  air  which 
.should  be  su])plied  and  ex- 
hau.sted  by  a  hospital  ventilat- 
ing system  varies  with  the 
nature  of  the  patients  or  dis- 
eases treated,  from  sixty  feet 
per  minute  per  occupant  in 
general  medical  wards  to 
100  feet  in  siu-gical  wards 
;i  n  d  wards 
ministering  to 
severe  cases, 
and  lf]()  to  1.50 
feet  in  operat- 
ing rooms  and 
in  wards  for 
contagious  di.s- 
eases,  the  aim 
in  the  latter 
case  being  not 
alone  to  give 
the  i)atient  the 


maximum      o  f 


lOURTII    FLOOR,    ADMINISTRATION    BUILDING    (OPER.VriNG 
PLANT;  STAMFORD  HOSPITAL,  STAMFORD,  CONN. 


help   but  to  protect    those  not    inoculated. 
In    the    case    of    wards    heated    entirely 
by   indirect  heat  the   quantity    of  air  sup- 
plied should,  in  any  case,  be  so  great  that  the 
temperature   thereof   need   not 
exceed  120  degrees  at  any  time. 
Special     and     separate     sys- 
tems of  fan  ventilation  by  the 
exhaust  fan  method  should  be 
provided  for  the  laundry,  kitch- 
en and  machinery  rooms.  Also 
another  separate  system  of  ex- 
haust fan  ventilation  should  be 
provided  for  all  toilets,  baths, 
slo|>sink  closets,  mop    closets, 
disinfecting,  refuse  rooms,  and 
similar     apartments.         It     is 
especially     im- 
portant       that 
this     be    made 
a  separate  sys- 
tem    of    ducts 
with     its     own 
fan  and  motor. 
It    will   thus  be 
a    snudler   sy.s- 
t  e  m     w  h  i  c  h 
should  be  kept 
ruimingtwenty- 
four  hours    a 
day   and  365 


22 


MOD  !•;  i{  \     II  ()-  r  I  r  A  i.-^ 


days  a  ycjir,  wlicrcas  in  Uiil  lew  cases  arc 
llic  main  cxliausl  fans  (t|)cralc(l  dniin^j,  llic 
siiMuiicr,  alllH)n^■ll  il  is  l'rc(|iicnlly  (lcsiral)lc 
tlial  llu'v  slioiiM  lie.  'I'lie  pi'opcr  rale  of  air 
cliaiiii'cs  in  llie  lOdins  connected  to  liiis 
s|)ecial  swsteni  will  \ary  IVoin  Iwelve  to 
twenty    |)cr   hour. 

A  general    rnle    t'oi'    air    sn|)|»ly    and    e\- 
lianst    is    to    snppK    air   lo    all     rooms    inio 
which    patients   may   enler,   and 
also    to    the    corridors,    and     to 
e.xhaiist    the  vitiated  air  from 
such  rooms,  ti'om  all  the  s|)ecial 
rooms    referred    to    aliove,  aiu 
from    auv    other    rooms   wlucli, 
l)ecauseof  their  special  use, would 
make  ventilation  desirable. 

Reference     has     heen      niad( 
above    to    the    condition    of    the 
air,  a  subject    upon    which    too 
much  emphasis   cannot    be  lai( 
It    should     be    free    from    dus 
for    dust    may    not     oidy     carry 
disease       germs 
but  il  is  a  .seri- 
ous irritant,  and 
if  it  reaches  the 
respiratory    .sys- 
tems of  the  pa- 
tients it  may  in- 
f 1 ic  t     i  n  j  u  ry 
therein,     and 
render    the    pa- 
tient   liable   to 
further     disease 
because    of    its 
physical       a  n  d 
germicidal    pro- 
[)erties.     Also,  it 
i  s    believed    b  y 
some  scientists 

that  the  dust  contains  nuich  vewtable  matter 
from  which,  when  comiiiir  into  conlaci  with 

I  •  •  • 

heatnig  surfaces  at  a  high  tem|)erature.  there 
nniy  be  distilled  harmful  gases.  I'rouble 
from  these  sources  may  be  obviated  by  re- 
moving the  dust  from  the  air  u.sed  for 
ventilation  by  means  of  filters. 

It  is  most  desirable  that  the  air  intake 
.should  be  high,  as  high  as  the  roof  line  if 
possible.  Actual  te.sts  by  Dr.  (irahani 
Rogers,  of  the  New  York  De|)artment  of 
Labor,  demonstrated  that  there  is  but  alxuit 
one-seventh  to  one-tenth  as  nuich  dust 
fiftv   feet   above   the   street  as   at   one  foot 


FIRST  .VXD  SKCOM)  I'l.OOUS. 
UOSIMI  .\l„  SIA 


abo\('  IIh;  sidewalk.  lb-  aUo  foutiil  that 
there  was  a  Iessene(l  proportion  of  oxidizable 
mailer  and  of  carbon  ijioxidc  in  the  air  at 
Ihe  greater  height. 

Itegardless  of  the  location  of  the  air  in- 
take all  air  entering  the  hospital  through  Ihe 
\'etililatitig  s\stcni  should  be  passed  through 
air  filters.  'I'licsc  nia\  lie  of  the  cloth 
t\|H'.  although  much  of  the  cloth  used  for 
I  his  purpose  is  either  too  coarse 
or  loo  fine,  insufficiently  strong, 
or'  full  of  sizing  which  in  damp 
weather  clogs  the  (Openings  in 
the  cloth.  Frequently  these  cloth 
screens  or  the  frames  therefor 
are  so  loo.sely  jnit  t<jgether  that 
he  filter  lo.ses  its  value  as  such. 
.\  better  apparatus  for  air 
filtratioti  is  the  air  washer, 
which  is  more  thorough  and, 
with  a  reasonable  amount  of 
altenlion,  is  easib  kept  in  (jrder. 
matter  of  dust  suggests 
the  importance 
of'  pi'ojiei-  eon- 
sfi-ucfion  of  air 
cluunbers  and 
air  |)assages. 
\\\  sides  thereof 
should  be  fln- 
i.shed  perfectly 
smooth  and 
should  be  as  ac- 
cessiljle  as  pos- 
sible, that  the 
interior  surfaces 
may  be  occasion- 
ally cleaned,  and 
that  they  m  a  v 
not  become  cul- 
ture tubes  for  the 
propagation  of  germs.  To  this  end  sheet 
metal  Hues  are  desirable,  but  where  ma- 
sonry chambers,  ducts  or  flues  are  used  thev 
.should  be  finished  perfectly  smooth. 

It  is  desirable  also  that  air  chandlers 
should  be  .subjected  to  as  much  davlight 
as  possible,  especially  sunlight,  because  of 
the  germicidal   properties  thereof. 

Ihnnidily  has  been  icferred  to  as  one  of 
the  essentials  of  good  ventilation.  Rela- 
tive humidity  and  temjierature  are  most 
intimately  associated.  It  is  true  that  a 
tenijieratiu'e  of  sixty  oi-  sixty-five  degrees 
with    a    relative   humidity    of   fifty   or   si.xty 


WAKi)  lirn.Di.NCi.  sr\Mi  <i 

Ml'OlU),  (  OXN. 


lil) 


is 


MODERN      HOSPITALS 


i  •^jiiiMJ  y^'"^: 


'Jo.':-\o.ou^  Waco.   ^TATinDco    MojP'TAl. 


per  cent,  is  more  comfortable  and  health- 
ful than  a  tenij)erature  of  seventy  or  seventy- 
five  degrees  with  a  relative  humidity  of 
twenty  j^er  cent.,  the  latter  condition  be- 
ing frequently  observed  in  our  homes, 
schools  and  hos])itals  during  the  winter. 
This  dry  atmosphere  is  trying  to  the  eyes, 
nasal  passages  and  skin,  it  produces  ner- 
vousness and  sleeplessness,  and  because  of 
the  evajooration  of  moisture  from  the  liody, 
which  rapidly  absorbs  heat,  it  causes  a 
feeling  of  cold  desjiite  the  high  tem]:)era- 
ture.  In  marked  contrast  is  a  reas()nal)ly 
humid  atmosphere  of  the  lower  tempera- 
ture, say  fifty  to  sixty  per  cent,  and  sixty 
to  sixty-five  degrees,  in  which  freedom  is 
had  from  the  above  annoyances  and  rest- 
fulness  prevails. 

It  is  not  true,  however,  that  the  tempera- 
ture may  be  lowered  and  the  humidity 
raised  with  a  resulting  saving  in  fuel,  for 
it  takes  vastly  more  fuel  to  evaporate  into 
the  air  the  amount  of  water  retpiired  to 
raise  the  humidity  than  is  saved  in  the  five, 
or  even  ten,  degrees  less  to  which  the  air  is 
heated.  In  determining  the  capacity  of 
the  boiler  and  in  considering  the  fuel  con- 
sumption allowance  nuist  be  made  for 
humidification.  Inasmuch,  however,  as  it 
means  the  difference  between  healthful 
and  trying  surroundings,  between  bright 
cheeks  and  eyes  or  sallow  cheeks  ami  (hill 
eyes,  between  wide-awake  minds  or  dull 
minds,   and   even    between    preservation    or 


destruction  of  furniture,  it  is  urged  that 
humidification  is  well  worth  its  cost.  Doubt- 
less within  five  years,  or  ten  at  the  most, 
a  hospital  or  school  without  provision  for 
himiidification  will  be  regarded  as  ineffici- 
ently equijiped. 

The  moisture  for  humidification  may 
be  introduced  into  the  air-su])])ly  system 
by  means  of  steam  jets  blowing  directly 
into  the  air,  by  means  of  vaporizing  pans 
containing  steam  coils,  or  by  means  of 
the  air  washer  to  which  reference  has  al- 
ready been  made. 

The  first  method  has  many  objections, 
the  second  serves  but  the  single  piupose 
of  humidification  and  is  not  so  well  adaj^ted 
for  large  installations,  while  the  third  meth- 
od serves  the  double  purpose  of  humidifica- 
tion and  air  filtration,  and  in  the  most 
convenient  manner,  especially  for  large 
installations.  Nor  is  the  cost  of  the  air 
washer  greatly  in  excess  of  that  of  a  really 
well  constructed  cloth  air  filter.  Its  man- 
ipulation is  easier  and  ex|)ense  of  upkeep 
little  dift'erent.  Discrimination  should  be 
exercised  in  selecting  the  ty[)e  and  make  of 
air  washer,  as  not  all  of  tiieni  are  entirely 
successful. 

The  relativ<'  humidity  may  be  aulomatic- 
ally  regulated  by  means  of  the  humidostat 
in  nuicii  the  same  manner  as  temperature  is 
auloniatically  regulated. 

We  are  much  less  a|)t  to  sullVr  willingly 
from    a   temperature  too   low   than    from   a 


U 


MODERN      llOSIMIAIvS 


tem[)eruture  loo  lii^li,  Iml  ;is  a  matter  ol' 
fact  an  exccssivt'ly  lii<rh  tt'in[)oratiire,  es- 
pecially if  accompanied  hy  ;i  lii<i;li  liuiiiidity, 
may  cause  a  rise  in  bodily  tcuipcraturc 
and  even  serious  functional  disturbances. 
Iiuisnuich  as  sufficient  radiation  must  Ik- 
|)rovided  for  the  coldest  hut  most  iid'ic- 
quent  day  of  the  year  it  is  not  stranj^e 
that  the  complaint  is  frequently,  and  usually 
un justifiahly,  made  of  too  nnich  radiation. 
Manual  control  is  almost  inijxtssihlc  of 
success  aiifl  an  automatic  temperature  regu- 
latintr  system  therefore  hecomcs  an  essen- 
tial  part  of  a  complete  hospital  heatmg 
and  ventilating  .system,  and  it  is  an  eco- 
nomical device  as  well. 

The  subject  of  direct  versus  indirect  heat 
for  hospitals  is  much  discus.sed.  The  direct 
radiators  have  the  advantage  of  making 
possible  the  quicker  and  less  expensive 
warming  up  of  the  rooms  upon  the  closing 
of  the  windows  and  of  giving  the  patients 
a  place  to  warm  feet  or  hands  at  such  times, 
the    absence    of    which    in    rooms    without 


su|)plcm(;ntcd  with  a  fresh  air  supjjly  and 
foul  air  exhaust  by  means  of  the  ventilat- 
ing system,  and  if  they  can  be  so  placed 
as  iu)t  to  be  too  clo.se  to  patients,  their 
presence  is  usually  regarded  as  desirable, 
bill  in  such  cases  .several  small  radiators 
g<'iicrally  distributed  are  [)rcfcrable  to  a  less 
ruimber  of  large  radiators  which  concen- 
Italc  llic  heat.  The  radiators  should  be 
plain  and  .smooth  and  should  be  su[)[)orled 
t'lom  the  walls  without  legs  with  a  space  of 
two  inches  back  of  them  .so  that  they  may 
be  kept  clean  as  well  as  the  wall  and  floor 
areas  in  the  vicinity. 

Concealed  piping  for  the  heating  .sy.stem 
is  regai'ded  as  preferable  in  that  it  lessens 
available  places  for  the  deposit  of  dust. 

Some  consideration  is  being  given  by 
the  medical  fraternity  to  the  subject  of 
artilicial  cooling  of  hospital  wards.  In  view 
of  the  results  of  recent  investigations  as 
to  the  effect  of  excessive  temperature  and 
humidity  it  is  rea.sonable  to  expect  that 
much  good  may  be  accomplished  in  severe 


WARD  FLOOR,  COiVrAGIOUS  WARD  HUILDI.XG,  STA.MIOUI)  HOSPITAL.  ST.\MFORD,  CONN". 


direct  radiators,  is  often  criticized  by  doc- 
tors. 

The  amoiuit  of  direct  radiation  used  in 
rooms  occupied  by  patients  may  well  be 
hmited  to  an  amount  sufficient  to  counter- 
balance the  heat  losses  through  wall  and 
glass  areas.  It  should  not  be  used  in 
operating    and    similar    rooms.     If    am]ily 


cases  by  lessening  the  temperature  and 
humidity  within  the  wards  in  hot  weather, 
lliere  is  little  available  data,  however, 
as  to  the  clinical  value  of  .such  an  arrange- 
ment. A  combiiuition  of  a  mechanical 
refrigerating  system  with  an  indirect  heat- 
ing and  ventilating  .sy.stem  for  cooling  pur- 
poses is  quite  possible. 


25 


MODERN      HOSPITALS 


Reca]>itiilating-,  the  essential  features  of  a 
hospital  veiitihitiug  system  may  lie  said  to  be: 

Ample  natural  or  window  ventilation. 

Supplementary  thereto  an  ample  supf)ly 
of  fresh  air  at  a  low  temperature  to  all 
rooms  used  by  patients. 

System  of  exhausting  the  vitiated  air 
from  all  such  rooms. 

S])ecial  exliaust  fan  systems  for  toilets, 
baths,  slop  sink  and  mop  closets,  etc. 

Separate  exhaust  fan  systems  for  laun- 
dry, kitchens,  machinery  rooms,  etc. 

The  operating  rooms  may  well  be  sep- 
arately treated. 


Air  intake  shoidd  be  located  as  high  as 
pt)ssible. 

x\ll  air  suj)plied  to  the  hospital  should  be 
freed  from  dust  by  means  of  filters,  pref- 
erably of  the  washer  type. 

Air  chambers  and  ducts  shoidd  be  fin- 
ished smooth,  and  so  far  as  possible  be 
subjected  to  light. 

Humidification  is  desirable,  and  even 
essential. 

Temperature  regulation  is  desirable  and 
a  source  of  economy. 

Direct  radiation,  of  a  limited  amount 
is  regarded  as  desirable. 


HOSPITAL    LIGHTING 

/,'//  K.  11.  HOSl'OCK 


is.  of  course,  rather  trite 
and  commonplace  to  say 
that  here  is  a  subject 
to  which,  considering  its 
importance,  the  architect 
has  not  given  sufficient 
study,  and  yet  if  it  is  of 
the  next  greatest  iin])ort- 
ance  to  sanitation  in  hos- 
pital building  as  it  should 
lank,  then  il  is  about  the  most  neglected 
sul)ject;  for  the  light  problems  of  a  hospital 
are  rather  peculiar,  and  caimot  be  met  by 
the  usual  methods  of  simply  providing 
enough  windows  or  lighting  outlets. 

It  is  the  unusual  hos|>ital  that  is  located 
where  it  ni.n  obtain  full  and  unrestricted 
light;  rallici'.  of  nc(('s>ity.  ai'e  they  in  such 
location^  in  url)an  districts  where  light  is 
cut  off  by  surrounding  buildings,  l)y  smoke 
or  dust,  and  sometimes  forfeited  to  avoid 
publicity.  Every  lios|)ilal,  of  necessity, 
carries  lighting  problems  of  its  own. 

Ill  hospital  lighting  one  great  help,  of 
course,  is  that  it  is  the  wise  custom  to  keep 
all  interiors  finished  in  while  eiiainel,  al- 
most altogether,  thus  giving  alxmt  the  best 
reflecting  surface,  and.  while  undoubtedly 
this  has  come  to  >tay,  if  architects  had  be- 
fore them  the  n-adiiigs  of  ligjit  efKciency  of 
rooms  finished  in  white  and  in  other  colors, 
they  would  be  glad  of  the  greater  efficiency 
shown   as   proving  their  wisdom. 


Daylight  lighting  of  hospitals  is  probably 
just  now  in  a  transitory  period,  inasmuch 
as,  for  the  feeling  of  safety  gained  by  its 
use,  wire  glass  is  being  used  as  a  means  of 
fire  protection.  In  hospitals  in  cities,  prob- 
alily  before  long,  building  codes  will  re- 
quire its  use,  and  in  grouped  or  connected 
Imildings  it  surely  must  l)e  adopted,  and  if 
such  a  possibility  is  admitted  to  exist, 
then  we  had  lietter  plan  to  meet  it. 

One  is  apt  to  think  of  wire  glass  as  the 
grade  usually  used  in  hreproofing  ware- 
houses, etc.,  forgetting  that  polished  wire 
glass  as  clear  as  ])late  except  for  the  mesh 
of  the  wire  is  j)rocurable.  and,  if  he  knows 
of  the  latter,  judges  its  price  as  being  as 
high  as  when  first  introduced  a  tew  years 
ago.  It  is,  however,  very  inuch  lower  in 
price  recently,  and  can  lie  used  to  great 
advantage  in  gla/ing. 

It  would  seem  that,  in  the  case  of  a  wing 
with  windows  on  three  faces,  that  ordinary 
rough  wire  glass  would  give  all  the  desired 
light  and  fire  protection  at  the  least  cost. 
When  rooms  can  only  receive  light  from 
one  e\|)osure,  however,  or  if  overshadowed 
by  buildings  across  the  street  to  the  exclus- 
ion of  light,  we  nuist  find  a  means  to  utilize 
all  the  available  light  Hu\  and  resort  to 
polished  wire  or  prismatic  wire  glass. 

I'risiii  glass  and  wire  glass  are  of  course 
known  to  architects  generally,  itut  possibly 
it    is   not    known    to   all    that    a   combination 


26 


MODERN      HOS  I'l  I  A  I.S 


of  them  prismatif  wire  glass  has  re- 
cently hecii   riiarkclcd. 

For  use  in  locations  facing  streets  or 
light  wells  tlic  niatMitaclnrcrs  make  prism 
glass  with  (lill'crcnl  angles  calcniated  lo 
turn  light  into  WniMings  at  approximately  h 
right  angle,  ami  hy  rererence  to  their  data 
the  glass  with  correct  angle  lo  suit  any  sit- 
uation may  he  procured,  and  a  double  sash 
window,  the  uj)[)er  sash  glazed  with  the 
proper  prismatic  wire  glass,  and  the  lower 
with  polished  wire,  would  seem  appro- 
priate,  if  cost   permits. 

It  has  become  the  custom  of  recent  years 
to  equip  each  hos[)ital  with  a  sun  parlor. 
The.se  usually  are  built  upon  the  roof  .so 
as  to  catch  all  possible  sun  and  light,  and 
built  with  an  insulating  space  sufficiently 
supplied  with  heat  between  the  outer  and 
inner  glass,  and  are  well  [)lanncd  for  tlieir 
purf)o.se,  but  it  occurs  to  the  writer  that  ad- 
vantage is  not  taken  of  an  opjjortunity 
here  in  using  the  therapeutic  (pialities  of 
light. 

For  instance,  certain  green  and  blue- 
toned  lights  are  depressing  in  effect,  and,  on 
the  contrary,  some  amber  and  rose  tone 
lights  are  cheering.  Now,  in  the  treatment 
of  certain  forms  of  melancholia  or  those 
where  low  spirits  retard  convalescence,  a 
corner  of  the  sun  parlor  glazed  wifli  light 
amber  (champagne)  tinted  glass  would  be 
of  great  value  it  would  .seem,  iji  bringing 
back  brighter  spirits. 

The  sash  could  l)e  made  to  (it  the  inner 
casing  and  movable,  .so  that  they  could 
replace  the  clear  glass  at  will,  or  even  be 
changed  for  other  glas.ses  having  known 
therapeutic  values  for  the  sunlight  to  l>ring 
out. 

Wherever  a  hospital  is  fortunate  enough 
to  possess  detached  operating  rooms,  or 
rooms  with  .skylights,  advantage  should  be 
taken  of  this  fact  to  jjrocure  light  by  having 
a  dome  constructed,  not  of  ground  glass 
as  has  been  frequently  done,  but  l)y  a  dome 
of  the  new  diffusive  glas.ses  in  sheet  form. 

In  the  question  of  artificial  light  the  first 
inquiry  is  what  .shall  be  the  medium,  and 
it  .seems,  too,  that  there  can  be  only  one 
answer,  as  electricity  so  nearly  fills  all  our 
requirements.  The  question  rather  seems 
to  be,  is  it  worth  while  to  use  combination 
fixtures  or  pipe  for  gas  at  all  f 

It  will,  of  course,  be  admitted  that  great 


danger  ensues  upon  the  use  f)f  gas  in  ward^ 
and  operating  looiu'^,  first  from  the  use  of 
light  fabrics  and  lints.  jukI  ;iU(,  from  the 
(langci's  that  slight  leakages  uilglil  have 
upon    weak   ami   susceptible  patient^. 

(ias  is,  of  course,  inq)ossiblc  where  sid- 
phuric  ether  is  handled  largely,  an<l  in  the 
days  when  chloroform  was  of  more  fre- 
(|uent  use  doctors  rememlier  \i\i(ll\  Ihe 
acrid    odor   of    burning   chlorofoi-m    vapors. 

No  electric  plant,  however,  is  infalliiile, 
and,  as  a  matter  of  insurance  again.st  its 
failure,  perhaps  the  majoritv  of  architects 
will  think  it  wise  to  have  the  buildings  fitted 
for  gas,  and  provide  the  neces.sarv  gas  out- 
lets to  tide  over  such  a  possibilitv. 

\\hafcver  fixtures  may  be  provided  should 
be  of  the  simplest  ty|)e,  with  no  more  or- 
namentation f)r  angles  to  calcji  dust  than 
can  be  avoided,  utterly  plain  spinnings 
and  tubing,  if  they  can  be  used  with  an 
enamel  finish  that  may  be  washed  if  nec- 
es.sary,  without  harm,  are  best. 

The  lights  provided  for  halU.  stairways 
and  corridors  should  be  as  far  as  j)ossible 
ceilinj''  dishes,  this  beinii-  the  form  easiest 
kept  clean,  and  the  glass  bowl,  if  to  be  used 
with  a  ground  or  acid  finisli  to  soften  light, 
.sliould  be  specified  "ground  or  finished  on 
the  inside." 

Wall  brackets  should  be  avoided  if  pos- 
sible. They  are  harder  to  kee|)  clean  and 
.sanitary,  and  there  are  known  in.stances 
of  patients  turning  on  gas  outlets  and  lea\- 
ing   tliem    undiscovered    for   a    long   period. 

The  color  values  of  light  in  relation  to 
hospital  work  deserve  a  few  words,  for  the 
nur.se  or  surgeon  must  of  necessity  decide 
sometimes  as  to  what  is  healthy  or  unhealthy 
tissue  by  its  color,  so  that  if  its  color  value 
is  cluingetl  very  much  from  that  of  its  dav- 
light  color  they  may  be  a  little  at  fault. 
Tlie  yellow  color  of  the  carbon  filament 
lam|),  sometimes  intensified  by  long  use,  can 
surely  be  improved  on  by  the  use  of  the 
tungsten  filament,  and,  while  we  have  con- 
sidered other  sources,  we  are  inclined  to  ad- 
vocate the  more  general  use  of  the  tungsten 
lamp  as  being  the  most  practical  white 
light  that  we  can  use.  having  in  mind  also 
its  low  cost  per  candlepower-hour. 

The  lighting  of  the  hospital  wards  is  one 
point  on  which  it  is  hard  to  come  to  a  de- 
cision, as  there  are  so  many  factors  to  be 
considered:     the     color,     the     amount,     the 


MODERN      HOSPITALS 


localizing,   the   mobility   of   units,   all   seem 
to  pull  against  each  other. 

The  first  thought  arising  probably  is  that 
s(mie  one  of  the  concealed  lighting  schemes 
would  be  of  great  value,  but  after  considering 
it  in  connection  with  other  features,  we  fear 
it  does  not  ap])ly.  Even  if  it  were  only  a  mat- 
ter of  enough  light,  the  strain  upon  the  eye 


FIG.  1 


of  a  patient  who  must  for  many  hours  keep 
the  tension  of  the  eye  muscles  set,  by  reason 
of  the  absence  of  restful  variations  of  light, 
would  cause  its  al)andonment.  Small  can- 
dlepower  units  are  often  needed  as  night 
lights,  and  again  high-powered  lights  are 
needed  for  some  attentions  that  must  be 
given  and  a  plug  and  cord  necessitating 
two  nurses'  care  is  surely  a  disadvantage. 
If  a  high-j)owered  lani])  is  used  under 
these  conditions  its  light  may  annoy  other 
patients  luiduly,  and  again  it  seems  wise  to 
arrange  units  that  can  be  brought  in  use 
at  any  bed  where  needed  as  quickly  as 
possible. 

As  a  matter  of  general  ward  night  light- 
ing, the  iustalliiig  of  two  or  three  ceiling 
clusters  with  ground  dishes  is  pr()b;il)ly 
as  o'ood  as  <-aii  be  done. 

But  for  general  purposes,  after  studying 
all  ciiuditions,  perhaps  a  fixture  built  from 
the  suggestion  in  the  accompanying  iliustni- 
tion   might  act  as  a  guide. 

If  the  "tongs"  feature  were  not  thought 
feasible,  this  might  be  replaced  by  telescopic 
tubes. 

It  is  designed  to  Ciirry  an  eiglit-c-andle- 
povvei'  carbon  and  a  foi'ty-caiidlepowci' 
tungsten  light,  and    for    ordinary  use  to  lit 


into  recess  in  wall  as  if  it  were  a  stationary 
sconce,  and  used  with  the  eight-candle- 
power  lamp  as  a  night  light  or  nurses' 
aitl  for  general  purpo.ses. 

When  for  examination  or  attention  a  good 
light  is  required,  the  light  which  would  be 
installed  over  every  bed  is  pulled  out  to  any 
position  where  it  will  stay  without  atten- 
tion, being  tight-riveted  in  every  joint 
of  the  extension  tongs  and  the  swivel  joint 
with  which  it  is  fastened  to  the  studding; 
the  rider  weight  is  used  to  keep  wiring  al- 
ways in  order.  The  shade  used  could  be 
built  doul)le  as  shown  in  cut,  and  if  light 
is  to  be  used  any  length  of  time,  the  upper 
part  be  slid  out  to  serve  as  a  screen  to  keep 
hght  from  annoying  other  ]>atients;  the 
shades  would  be  of  light  sheet  metal  with 
white  enamel  finish,  therein'  acting  as  re- 
flectors and  when  pushed  back  into  wall 
as  sconce  being  in  touch  with  wall  finish 
and  almo.st  unnoticeal)le. 

AVhile  not  really  in  topic,  it  would  seem 
best  to  provide  a  push  socket  outlet  below 
this  in  wall  for  use  if  electrically  oj)erated 
instruments  may  be  used. 

In  operating  rooms  care  must  be  taken  to 
proviile  enough  light  in  all  ])ortions  of 
room  so  that  nurses  may  never  be  at  a  loss 
in  reading  laltels.  etc..  but  the  question  of 
proper  lighting  for  the  operator  is  a  matter 
of  graver  discussion. 

riie  usual  procedure  has  been  to  |)rovide 
a  cluster  of  carbon  filament  lam|)s  of  sup- 
po.sedly  sufhcient  power  at  a  height  of 
about  twenty-four  inches  above  the  level 
of  operating  table.  The  candlepower  us- 
ually installed  was  from  120  to  '-200,  and 
yet,  while  this  would  seem  to  be  ample, 
surgeons  are  continually  complaining  as 
to  light,  and  either  require  nurses  to  hold  a 
portable  light  close  to  the  ])oinf  of  operation 
or  wearing  a  head  lamj)  with  a  reflector  to 
hei|)  them. 

One  mistake  has  been  that,  the  light  liav- 
iu"'  usually  l)een  from  a  relatively  small 
area,  whenever  the  hand  of  the  surgeon  was 
Interposed  of  necessity  l)etw(>en  the  area 
of  light  source  and  the  |)oint  of  o|)eration, 
a  shadow  was  cast  that  was  inconvenient. 

Perhaps  this  (piestiou  could  best  be 
solved  by  the  use  of  a  circular  or  rather 
hexagonal  fixture  built  up  of  say  six  three- 
foot  units  of  reflecting  trough  as  shown, 
canying   lamps   of  forty-candlepower  tung- 


28 


Moi)Ki{\     Fiosrri  A  I.S 


sten  tv|H;  lillcd  willi  ii  llulcd  jrlass  rcllcctor 
desio^iu'd  ;it  angles  to  throw  all  the  light 
within  a  circle  of  two  I'eel,  dianiclci'  at  the 
height   of  an   opei'ating  taMe.      'I'liis  lixtnrc 


m^^ 


.  >l  I  H 


I 


I ;  1 1 . "  1 1  r  ; 


i''i(;.  o 


niiglit  be  hung  at  height  completely  out 
of  way  of  surgeons,  and  yet  throw  easily 
two  or  three  times  the  light  availaMe  imder 
present  systems  upon  the  work,  and  if 
diameter  of  circle  be  kept  at    about  six  feet 


the  surgeon  cannot  create  a  shadf)W  that 
will  tr(»nl)le  him. 

'I'iie  color  of  iiglit  has  also  been  considered 
ill  recommending  timgsten  lamps;  the 
slow-starling  lights  niight  at  times  waste 
vahiahic  seconds,  and  the  tid>e  lights  might 
indeed  by  the  breaking  of  a  unit  cause 
lioidilc;  whereas  the  breaking  of  a  fila- 
ment lanif)  or  two  would  in  a  circle  of  such 
lights  be  no  great  incfjtivenience. 

Jn  the  matter  of  the  liirhtin";  of  clinical 
amphitheatres  as  attac-hed  to  most  hosf)itals 
we  thiidv  a  fixture  f)f  this  ty[)e  desirable, 
also,  except  that  it  had  j)rol)at)ly  be  better 
suspended  by  chain  so  as  to  give  as  few 
lines  as  possible  to  obstruct  vision. 


CONTAGIOUS  GROUP  OF  THE  PROVIDENCE  CITY 

HOSPITAL 

MESSRS.  MARTIN  &    HALL,  ARCHITECTS 


[IIS  particular  hospital  is 
uiH(|ue  in  construction 
and  in  its  administration 
because  it  is  probably  the 
first  hospital  to  be  estab- 
lished in  this  country 
where  contagious  diseases 
are  treated  on  the  theory 
of  contact  infection, 
which  means,  when  defined,  tliat  such 
diseases  are  not  carried  by  the  air  but  by 
something  or  somebody  coming  in  contact 
with  patients  suffering  from  a  disease  and 
transmitting  it  to  the  healthy  individual. 
Heretofore  contagious  diseases  have 
usually  Ijeen  combated  on  the  theory  that 
diseases  are  carried  by  the  air  and  it  is 
only  very  recently  that  physicians  and 
hospitals  have  begun  to  adopt  the  theories 
of  Pasteur  on  the  subject  of  contact  infec- 
tion. He  estal)lished  a  ward  in  Paris,  in 
which  a  varietv  of  diseases  were  treated  in 
the  same  building,  under  dehnite  rules  and 
requirements  as  to  care  on  the  part  of 
nurses  and  others  coming  in  contact  with 
tlie  patients,  and  secured  definite  results. 
Eighteen  montJis  of  practice  of  these  theories 
in  the  Providence  City  Hospital  has  indi- 
cated that  they  are  soiuid. 

The  following  extract  from  the  report  of 
Dr.  Dennet  L.  Richardson.  Superintendent. 


clearly  explains  the  method  employed  in 
securing  the  very  best  results  from  the 
building  as  designed  and  planned. 

"The  opening  year  of  the  hos])ital  has 
presented  numy  problems.  It  has  not  been 
easy  to  bring  together  efficient  help  (for 
many  of  the  employees  had  never  had  anv 
previous  hospital  experience),  and  establish 
a  routine  based  on  the  principles  and  prac- 
tices of  other  hospitals  and  adapt  them  to 
our  own  needs.  We  have  had  to  make 
changes  and  expect  to  make  more  to  im- 
j)r()ve  the  service.  The  peculiar  problems 
relate  to  the  method  by  which  we  have 
started  out  to  handle  contagious  di.seases. 
It  is  based  on  the  theory  of  contact  infec- 
tion, which,  defined,  means  that  these  dis- 
eases are  not  carried  by  the  air  but  by 
something  or  .somebody  which  has  come 
in  contact  by  touch  with  a  j)atient  suffering 
from  one  disease  and  transferred  it  to  the 
healthy  individual.  As  a  working  basis, 
contact  infection  is  made  to  include  po.s- 
sible  infection  by  coughing  upon  anything 
or  anyone  at  short  range.  While  perhaps 
this  is  the  fir.st  time  this  practice  has  been 
employed  in  this  country,  it  has  been  suc- 
cessful in  certain  hospitals  in  England, 
France  and  (Jermany. 

In  tlie  treatment  of  all  the  contagious 
diseases    contact    infection    is    avoided    bv 


29 


MODERN      HOSPITALS 


1 

'     1    i 

B  1 

^^^^ 

1 

1         f 

■■;:j 

11  3  n  3 

GENERAL  VIEW  OF  GROIT,  PROVIDENCE  CITY  HOSPITAL,  PROVIDENCE,  R.  I. 


strict  ase]).sis,  and  air  infection  has  been 
disregarded.  Nurses,  orderlies,  maids  and 
all  the  help  are  carefully  instructed,  first, 
how  to  protect  themselves,  and,  secondly, 
how  to  avoid  transmitting  infection  from  one 
ward  to  another,  or  from  one  patient  to 
another.  The  following  set  of  rules  is 
given  to  everyone: 

"Keep  finger,  pencils,  pens,  labels  and 
everything  out  of  your  mouth. 

"Keej)  and  use  your  own  drinking  glass. 

"Do  not  kiss  a  patient. 

"Wash  hands  often  and  always  before 
eating. 

"Keep  (Mit  of  doors  as  much  as  possible 
and  always  sleep  with  your  window  open. 

"Do  not  touch  face  or  head  after  handling 
a  patient  until  hands  are  washed. 

"Do  not  allow  patient  to  cough  or  sneeze 
in  yovu'  face. 

"Do  not  eat  anything  that  patient  may 
wish  to  give  you. 

"If  taking  a  drink  or  lunch  1)6  sure  and 
u.se  the  nurses'  dishes. 

"Put  on  gown  or  change  uniform  when 
going  into  the  ward. 

"On    leaving  ward   always  wash   hands. 

"Always  remember  that  infectious  dis- 
eases are  carri<'d  by  contact  and  not  by  air 
infection." 

The  nurses  all  occupy  the  same  dormi- 
torv  and  eat  in  the  same  dining-room. 
When  ready  for  (bily  they  go  to  a  dressing- 
room  where  they  put  on  a  ward  unifornL 
Each  nurse  is  provided  with  two  lockers, 
one  for  her  ward  clothes  and  the  other  for 
the  imil'orm  worn  when  off  duty.  On 
leaving  the  ward  she  changes  again,  wa.shes 


her  face  and  hands  and  dries  them  on  an 
individual   towel. 

The  ward  maids  live  with  the  other  fe- 
male help  and  eat  in  the  help's  dining- 
I'oom.  They  observe  the  same  rules  as 
do  the  nurses,  with  the  exception  of  wearing 
a  long  gown  instead  of  removing  the  outer 
garments. 

The  resident  physicians,  when  making 
their  visits,  wear  white  suits  and  put  on  a 
gown  in  each  separate  ward.  This  is  not 
always  done  unless  they  are  likely  to  exam- 
ine patients.  No  caps  are  worn.  Great 
care  is  taken  in  washing  their  hands. 

Soiled  clothing  is  thrown  down  a  chute 
and  falls  into  canvas  bags  which  are  regularly 
collected.  One  man  is  delegated  to  take 
the  clothing  to  the  laundry,  where  it  is  put 
directly  into  the  ordinary  washers  and 
washed  in  boiling  water  from  forty  to 
sixty  minutes.  The  man  wears  a  gown 
and  washes  his  hands  thoroughly  after 
handliuti-  the  infected  clothing.  The  clean 
clothing  is  delivered  to  the  wards  in  bundles 
tied  up  in  cloth. 

'J'he  iuiml»cr  of  dishes  which  must  pass 
between  the  main  kitchen  and  the  ward 
kitchen  has  been  reduced  to  a  minimum, 
but  such  as  do  are  carefully  boiled.  All 
garbage  is  burned. 

I  believe  that  the  most  fertile  source  of 
infection  is  the  patient  himself.  It  is  very 
important  to  nuike  a  correct  entrance 
diagnosis,  tt)  rule  out  mixed  infections  and 
if  tlicrc  is  any  doubt,  to  isolate  tlie  case  until 
a  decision  is  reached.  New  patients  are 
taken  to  tlic  a<hiiitting  room  in  each  ward, 
ulici'c     tlicv     arc    carefully     exauiincd,     the 


30 


M()F)F;I{\       IIOSI'IIALS 


history  and  physiciairs  cxaiiiiiialioti  care- 
fully r(>c<>r(l('(l  and  llicn  arc  sent  eillier 
to  fielention  rooms,  oiundcd  |)\'  ;i  i-cd  cjipd 
if  necessary,  or  sent  lo    tiie    isolation    ward. 


^\  c  lia\c  alic;i(|y  found  our  is<jlafion 
ward  insnflicieni  and  have  heen  ohlif^ed 
lo  isolate  some  nnxed  cases  in  the  di[jh- 
llieria  and    scarlet   fever   wards.       To   fnlfil 


4. 

Kuolll. 

24. 

Sewinjf  Room. 

32. 

G. 

Lavatorv. 

25. 

Chamber. 

33. 

7. 

Batli. 

26. 

Nurses'  Diiiintj  Koorn. 

34. 

8. 

Linen  Clo-set. 

27. 

Servinij;  Rooni. 

35. 

!). 

(  'IdspI. 

28. 

Df^tors'  Diiiiiip;  IJooiii. 

36. 

13. 

Corridor. 

19. 

Women's  [^avatory. 

37. 

14. 

Stair  Hall. 

30. 

Men's  Lavatory. 

38. 

'23. 

'I^iiniiel. 

31. 

Doctors'  Bath. 

30. 

FIRST  FLOOR  PL.\.\,  .VD.MINlSTR.Vno.N'  BUILDING 


Internes  Chamher. 
Superintendent's  Parlor. 
Superintendent's  Living  R(M)m. 
Superintendent's  (  hamber. 
Superintendent's  Office. 
Matron's  Office. 
Waiting  Room. 
Nurses'  Sitting  Room. 


tU.  .Matron's  Sitting  Room. 

41.  Matron's  Chamljer. 

42.  Matron's  Bath. 

43.  Nurses'  I^aundrj'. 

44.  Servants'  Dining  Room. 
4.5.  Pharmacy. 

4().  Trunk  Room. 


SECOND  FLOOR  PL.AN,  .\DMINISTRA HON   BUILDING 


Even  if  the  diagnosis  .seems  j)lain,  all 
patients  are  placed  in  detention  rooms  for 
several  davs,  where  they  are  meanwhile 
treated  as  suspicions  cases. 


the  same  purpo>c  of  the  harrier  .system  of 
the  Kiiuli^li.  we  lumg  on  the  bed,  or  put 
on  tin-  door,  a  red  card  on  which  is  printed 
"Sjiecial  Case."      Hands  are  washed  before 


31 


MODERN     HOSPITALS 


and  after  handling  the  i^atient  and  a  gown 
is  worn.  Every  such  patient  has  his  own 
bed  pan,  urinal,  thermometer,  and  all  his 
dishes  are  sterilized.  Every  patient  has 
cultures  on  the  first  two  days  of  his  hos- 
pital residence,  and  one  is  taken  in  the  ad- 
mitting room  before  he  comes  in  contact 
with  any  other  patient.  If  the  cultures  are 
positive  in  any  but  the  di])htheria  wards, 
the  case  is  isolated.  Soap  and  water  alone 
are  used  for  cleaning  hands,  floors,  walls 
and  furniture.  Mattresses  are  sterilized 
by  steam.  Rubber  goods  and  glass  ^oods 
are  treated  with  carbolic  acid  1-20.  Fumi- 
gation is  never  done. 

I  wish  now  to  speak  of  the  results  of  the 
treatment  of  cases  in  the  isolation  ward, 
where  are  carried  on  the  same  precautions 


as  will  be  used  constantly  and  can  be  kept 
in  the  room  as  long  as  the  patient  occupies  it. 
Utensils,  dishes  and  trays  after  being  taken 
from  the  room  are  put  directly  into  a  large 
utensil  sterilizer  in  the  ward  kitchen  and 
sterilized  by  steam  and  hot  air  before  they 
are  washed.  The  ward  kitchen  is  thus 
kept  uninfected,  and  the  trays  of  food  are 
made  up  and  taken  directly  to  the  different 
rooms.  All  rubber  goods,  glassware,  bed 
pans  and  urinals  are  sterilized  in  1-20 
carbolic  solution. 

Only  physicians  and  nurses  are  allowed 
in  these  rooms.  If  they  simply  go  in  and 
do  not  touch  anything  in  the  room  no  pre- 
cautions are  taken.  If  the  patient,  or  any- 
thing in  the  room  is  touched,  the  hands  are 
washed   with    soap    in   running   water   and 


TlllIiL)  FLOOR   PLAN,  ADMINISTRATION  BUILDING  (Ser  Key  <m  Pmje  SI) 


as  are  practised  on  the  red  card  cases, 
but  more  effectively.  On  the  first  floor 
of  the  isolation  building  are  ten  rooms, 
five  on  each  side  of  a  common  corridor. 
The  doors  are  opposite  to  each  other,  and 
beside  each  and  opening  into  the  same  room 
is  a  full  window,  sf)  that  a  luu-se  may  pass 
along  the  corridor  and  note  what  is  going 
on  in  each  room  without  entering  the  door. 
Each  is  provided  with  running  water, 
controlled  by  levers,  which  are  operated 
by  the  forearm,  to  avoid  contact  by  hands. 
The  furniture  consists  of  a  chair,  a  metal 
bed,  and  bedside  table,  so  constructed 
that  they  can  be  easily  and  thoroughly 
cleansed.  The  patient  once  |)laced  in  a 
room  is  not  allowed  out  of  it  unless  taken 
out  of  doors,  and  seated  by  himself.  lie 
is  j)rovided  with  a  thermometer,  pus  basin, 
hand  basin,  ice  bag  and  so  forth,  such  things 


dried  on  individual  towels.  If  the  patient 
is  handled  much  or  examined,  gowns  which 
hang  in  the  rooms  are  put  on.  The  care 
of  the  hands  is  rigidly  insisted  on.  Toys, 
books,  etc.,  are  either  sterilized  or  burned 
after  the  patient  goes  home.  On  discharge 
of  a  patient  the  bed  and  furnitine,  floors, 
door  knobs,  wash  basin  and  walls  AAithin 
reach  are  washed  with  soap  and  water. 
Dirty  clothing  is  sent  to  the  laundry.  The 
mattress  is  sterilized  by  steam.  The  room 
is  aired  as  long  as  possible  until  there  is 
another  patient  to  occupy  it. 

The  s(>con(l  story  of  the  isolation  ward, 
consisting  of  one,  two  and  three-bedded 
rooms,  has  l)een  ])rovided  with  running 
water,  sterilizer,  etc.,  such  as  the  first  story 
is  provided  with.  This  was  o})ened  early 
in  Jajuiary,  1911.  and  we  now  have  amj)le 
facilities     for    isolating     twenty-five     cases. 


S£ 


MODKliX      HOSPITALS 


l^licsc  aseptic  |)rlri(i[)l('.s  are  lahorioiis 
and  icMjuirc  llioiiglit  and  great  care.  Most 
of  the  credit  and  success  of  satisfactorily 
treating  cases  in  this  way  belongs  to  the 
nursing  force. 

The  doors  are  left  wide  open  and  the  w  ind 
sweeps  freely  through  the  rooms  in  warm 
weather,  wlien  tlie  windows  are  opened  also. 

From  the  opening  of  the  hosj)ital  March 
1st,  to  the  close  of  the  hospital  vear  Decem- 
ber .'51st,  there  were  treated  in  lliis  ward 
140  cases,  representing  1!>(I  diirerenl  dis- 
eases. These  diseases  were  divided  as 
follows : 

Scarlet  Fever ' 38 

Diphtheria IS 

Measles SS 

Chicken-pox (i 

Whooj)ing  Cough 29 

Mumps 5 

Positive  Di])htheria  Cultures 21 


Coiiorrheal  Vaginitis. 

Rubella 

Krysij)elas 

.\on-conta<fi()Us  Disea.ses. 


7 

2 

1 

25 


Tola!     190 

At  all  limes  there  have  been  varving 
cond)inations  of  Ihe  aliove  diseases  in  the 
ward  al  the  same  lime.  When  there  are 
only  a  lew  cases  of  chicken-jiox,  measles  and 
whooping  c-ougli,  they  are  jmt  directly  into 
this  ward  anfl  kept  there  until  discharged, 
because  it  saves  on  nursing  force  and  it  has 
.seemed  .safe  to  treat  them  there.  One  ca.se 
of  mea.sles  and  one  case  of  chicken-pox  have 
developed  among  the  140  |)ersons  treated 
in  this  ward,  although  they  are  j)ractically 
in  the  same  ward,  and  nurses  pass  from  one 
to  another,  ob.serving  the  necessarv  precau- 
tions. No  case  of  cross  infection  has  arisen 
in  eight  months. 


33 


HOSPITAI.  lU  ILI)1N(;,  BKOOKLVX  (  HILDREN'S  AID  SOCIETY  SEASIDE  HOME.  (  OXEV  ISEAXD.  X.  V. 

MH.   EDWARD  PE.VRCE  CASEY,  ARrHITECT 

SEASIDE  HOSPITAL  OF  THE  BROOKLYN  CHILDREN'S  AID 
SOCIETY,  SURF  AVE.,  CONEY  ISLAND,  N.  Y. 

EDWAKI)    I'KAIUE   CA.SEV.    ARCHITECT 


HIS  hospital  is  an  exten- 
sion of  the  former  phuit 
of  the  Society,  eonsistino- 
of  a  niiml)er  of  frame 
Kuildinu's  and  cottages 
froiitinfi,-  upon  the  !)eacli, 
and  is  intended  primar- 
ily in  its  phmnino-  for  tlie 


(Iren  during;  tl 


treatment  of   voung  chil- 


le  su 


nimer  months. 


The  site  is  an  entire  hh)ck  located  hack 
of  the  present  group,  and  was,  at  the  time 
operations  were  l)e<i,un,  in  its  primitive 
condition  of  drifting  sand  dunes,  ten  or 
twelve  feet  high,  of  tine  white  heach  sand, 
which  afforded,  of  course,  an  excellent 
foundation    for   the    walls   of   the   structure. 

'i'he  hospital  c()mj)rises  the  main  huild- 
ing.  some  'iOO  feet  in  each  dirc<tion,  and 
;i  detached   laundrv  huilding  in   the  rear. 

In  these  two  l)uildings  are  found  |)rac- 
tically  all  the  elements  of  llic  niodcru  lios- 
[)ital  estal)iishiueiit ;  wards  and  sc|)aralc 
rooms  for  patients;  the  aduiinislralioii, 
including  c-cnlr.il  reception  room,  willi  ad- 
jacent waiting  room,  doctor's  oilice,  licad 
nurses  oflice    and    drug  nxjni,   and   in   the 


rear  of  these  the  general  dining  room, 
nurses'  dining  room,  kitchen.  ])antrv  and 
store  room.  There  is  also  an  operating 
room  witli  dependencies  and  equij)ment 
in  the  way  of  various  kinds  of  sterilizers, 
etc.  A  milk  laboratory  wheret  he  milk  for 
infants  is  ])repared.  bottled  and  svdj.se- 
quently  distril)uted  to  the  various  diet 
kitchens  is  also  centrally  located.  At  either 
extremity  of  the  l)uilding,  on  both  floors, 
are  grou|)s  of  dependencies,  each  consisting 
of  a  diet  kitchen,  a  general  lavatory  and. 
bath,  an  irrigating  room,  fitted  with  sinks 
and  slat)s  for  the  treatment  of  infants, 
and  a  linen  clo.set. 

A  small  ])athological  room  is  provided 
\\itli  facilities  for  reseai'cli  in  disease,  as 
well  as  a  morgue  i-oom  in  an  isolated  posi- 
tion   in    the   basement. 

Acconunodations  arc  aifordcd  for  a  total 
of  I'-iO  childi-cn.  including  lliose  for  sixty 
cliildicn  accompanied  by  their  mothers, 
each  of  whom  occupies  a  separate  room. 

These  I'ooms  have  dooivs  o|>ening  upon 
Ihe  balconies,  as  well  as  u|ion  Ihc  interior 
corridors,  and  are  furnished  witli  beds 
pro\idc(l  with  small  cradles,  swinging  from 


34 


MOD  K  l{  \       II  OS  r  I   I'  A  f.S 


davits  ill  llic  I'liiil  for  the  con v<'iiiciil  ac- 
commodation (if  I  lie  child,  'riicrc  arc  lic- 
sid<'s  I'oiir  small  wards  cMiilainini;  ^cvcn 
cribs  cacli,  and  two  larger  \\ai(l>  each  uilli 
sixteen  crihs  arranged  in  Iwu  row^  dnwii  llic 
center  of  the  wanl. 

Ill  tlic  second  storv  of  the  rear  win;;  Ihc 
mirses  are  <|iiartered  in  sixteen  separate 
rooms,  while  in  the  second  slorv  of  the 
laundr\  Imildin^'  the  xarions  emplosees 
ure  (juarlercd  in  eleven  rooms. 

The  open  court  of  Ihe  Knildini;'  at  the 
front  faces  tiie  south.      The  |)ro  eciiii^'  w  iuji;.s 


.^ 


.^1 


ftt 


.\CORNF.U  OK  KUONT  COURT,  IK  )SI'irAI.  HI  II, DIM., 

liltOOKLVN   (  llll-DMKNS  All)  S()(li;i\    Si;\SII)i: 

IIOMK,  CONKV  ISLAND.  N.  V. 

MK,    KDWKHl)   I'KAlill-:  I'ASEV,  AliCHITKCT 

on  either  side  of  this  court  are  occii|)ie(l 
mainlv  hv  tlie  small  rooms  and  small  wards 
for  tlie  infant  })atients  and  their  motlieis. 

The.se  wing.s  are  entirely  surrounded  on 
three  sides  with  covered  balconies  on  both 
floors.  Doors  from  the  rooms  open  dir- 
eetlv  upon  the  balconies  and  atford  ready 
means  for  the  ex|)e(litious  ri'iuoxal  of  |)a- 
tient.s  for  open  air  treatment. 

The  plan  of  the  hospital  has  been  ar- 
ranged with  a  view  to  the  provision  of  the 
greatest  amount  of  air  and  thorough  circu- 
lation. 

Tlie  main  corridoi'  running  across  tlu" 
building  at  the  front  may  be  opene<l  nj)  in 
the  warm  weather  so  as  to  make  it  \  irtiiallv 
ail  o])en  air  balcony,  similar  to  those  sui- 
roimding  the  wings.  Besides,  all  corridors 
terminate  in  either  window  or  door  open- 
ings in  the  outside  walls,  while  short  cross 
corridors  are  providml  in  the  wings,  all  a> 
an  additional  indiicenieiil  to  Ihe  inlerioi' 
circulation. 

The    Hat    r(n)f   over    the    whole    building. 


1 W  fW  mmm 


I.OOKl.NC  A(  liOSS  MiONI'  <  Olli  T,  IIOSITI  \l.  lillLI)- 

l\(;.  li|{0()KI.^  \  (  IIILDRKN'S  All)  SOCIKTV  SK.V- 

SIDI    IKiMK,  CONKV  ISLAND,  N.  V. 

\II(     I  UUMill   J-KAR(  K  fA.SKY,  AKIIIITEtT 

a])pi()ached  as  il  is  by  the  main  staircase, 
also  affords  opporlunily  for  open  air  treat- 
iiicnl  under  fa\orable  conditions  of  the 
weather. 

All  openings  arc  filled  with  casement 
sash  or  iloors,  as  the  case  may  be,  with 
Iraiisoiii  s;isli  oNcrlicad  in  c\'cry  instance, 
Iherebx     alfordiii:^     means    of    ulili/in<f    the 

*  - 

entire  ai'ca  of  Ihc  opening  for  the  passage 
of  ail',  or  of  niodif\ing  il  to  an\  desired 
aniounl. 

T\\v  space  lielwcen  ihe  roof  and  the 
ceiling  of  the  second  story  affords  a  non- 
conducting air  protection  against  the  heat 
of  summer,  and  Ihe  cold  of  winter,  and  for 


I.OOKINt.    INK)    IKONl    (OlKl.   lICisl'llAL   lil  ILD- 

IN(;.   MHOOKLVN  (  IIILDKKNS  .\ID  SOCIETY 

SK.VSIUK  IIOMK,  (  ONKY  ISL.\XD,  X.  Y. 

MR.   F.nWAHn  PEAROE  r.\SEV.  ARCHITECT 

the  purpose  of  renewing  the  air  as  it  l)e- 
coines  liealed  in  snininer,  numerous  small 
openings  are  j)laced  in  the  walls  under  the 
cornice.      These  openings  are  provided  with 


35 


MODERN      HOSPITALS 


WING,  COXTAIXIXG    S:\IALL   ROOMS    AND    ^YARDS. 

HOSPITAL  BUILDING,   BROOKLYN   CHILDRENS 

AID  SOCIETY  SEASIDE  HOME,  CONEY  ISLAND, 

N.  Y. 

MR.   EDWARD  PEARC'E  CASEY.  ARCHITCT 

movable  louvres,  which  serve  to  prevent 
the  escape  of  such  heat  as  this  air  may 
contain  durine;  the  cold  weather. 

The  space  under  the  floor  of  the  hrst 
story  is  also  provided  with  louvred  openings 
to  admit  of  a  ]iroper  regulation  of  the  air 
under  the  building. 

A  complete  circulating  .steam  j)lant  is 
installed,  which  will  allow  oj^eration  of 
the  hosj)ital  throughout  the  entire  year, 
although  this  is  not  at  present  contemplated. 
The  boiler  is  located  in  a  cellar  under  the 
kitchen  and  is  of  cast  iron  sectional  type. 

The  radiators  are  direct  and  are  located 
under  the  window  o])enings  in  order,  as 
is  usual,  to  counteract  the  natural  cold 
currents  at  these  points. 

A  high  ])ressure  boiler  is  also  provided 
to  furni.sh  .steam  for  use  in  the  ojjeration 
of  the  laundry,  as  well  as  to  provide  steam 
for  sterilizers  in  the  operating  department 
and  in  the  milk  laboratory,  and  also  for 
cooking  a])paratus  in  the  kitchen. 

Electricity  is  cm])l()yed  for  all  lighting, 
as  well  as  for  operating  the  laundry  ma- 
chinery and  for  ironing. 

Gas  is  introduced  sini])ly  to  supply  small 
cookers  in  the  did  kitchens,  and  as  an 
auxiliary  in  the  main  kitchen,  and  to  supply 
stcriHzcrs  in  the  operating  rooms  ;iiid  doc- 
tor's ollice. 

The  con.struction  of  this  plant  is  inter- 
esting ni;iinly  as  affording  ;in  exanipU'  of 
fireproof  hospital  construction  at  a  re- 
markably low  co.st,  as  this  amounted  to 
.sixteen  cents  j)er  cid)ic  foot,  iiichidiiig 
laundry  machinery  atid  all  a])paratus  of  a 
fixed  nature,  excepting  sterilizers. 


The  construction  to  the  level  of  the  first 
floor  is  in  gravel  and  Portland  cement 
concrete.  The  outer  walls  of  the  first 
story  balconies  are  sn])ported  on  concrete 
arches  between  piers  of  the  same  material, 
the  arches  being  concealed  below"  the  grade 
line. 

The  cellar  under  the  kitchen,  which  con- 
tains the  boilers,  'water  heater  and  coal 
storage,  was  placed  with  some  difficulty 
about  four  feet  below  the  water  level  in 
the  fine  shifting  beach  .sand.  The  cellar 
bottom  w^as  made  very  heavy  of  concrete 
mixed  with  waterproofing  compound,  and 
heavily  reinforced  with  the  tension  bars 
near  the  top  of  the  slab,  in  order  to  resist 
the  upward  pressure  of  the  ground  water. 

The  outside  walls,  including  the  roof 
])arapet  walls,  are  constructed  of  heavy 
interlockino-  terra-cotta  tiles,  affordino-  within 
the  wall  sufficient  inclosed  air  spaces  to 
insure  a  dry  and  non-conducting  wall  with- 
out the  u.se  of  furring  on  the  interior  surface. 

The  balcony  piers  and  arches  are  con- 
structed of  brick. 

All  interior  partitions  are  of  terra-cotta 
tile  of  various  thicknes.ses. 

The  first  floor,  including  the  floor  of 
the  balconies,  is  entirely  of  reinforced  con- 
crete, of  beam  and  slab  con.struction,  while 
the  second  floor,  including  the  balconies, 
is  a  combination  of  reinforced  concrete 
beams  filled  between  with  terra-cotta  blocks. 
This  latter  method  of  construction  produces 
a  flat  ceiling,  without  resorting  to  the  ex- 


MAIN     rUAXSVEUSE. CORRIDOR,   HOSIMIAL   liUH.D- 
IN(;,  BKOOKIAN  CHILDREN'S  AID  SOCIETY  SEA- 
Sn)E  HOAH',    (  OXEY  ISLAND,  N.  Y 

MU.  I.I)«AI(D  I'EARCE  CASEV,  ARCHITECT 


3() 


MODERN      HOSPITALS 


pense  of  fiiniiij^,  and  tlicrchy  docs  ;i\viiy 
with  llic  minicroiis  surriicfs  and  angles 
produced  l)y  u  l)cain  cciliii';',  which  tend  to 
the  coMeclion  of  (hist  and  coltwehs. 

The  stairs  are  likewise  constniclcd  of 
reinforced  concrete  and  are  finislicd  witli 
shite  treads,  and  otherwise  witli  tlie  same 
liard   finish  that  is  a|)|)Hed   to  the  walls. 

Trim  is  used  only  in  the  o|)cnin^s  of 
thin  interior  parti- 
tions, and  this  is  of 
as  .sim|)le  and  non- 
(i  u  s  t  -  collect inj;' 
character  as  pos- 
sible. 

Tlie  w  i  n  d  o  w 
openings  are  with- 
out trim,  with  the 
wall  plaster  round- 
ed in  to  meet  the 
frame.s. 

In  fact,  all 
angles  of  the  plast- 
er work,  both  sali- 
ent and  re-entrant, 
are  rounded,  as 
well  as  the  angles 
between  the  floors 
and  the  walls, 
which  are  finished 

with  a  Portland  cement  base  made  flush 
with  the  finished  wall  surfaces. 

By  these  means  all  surfaces  and  parts  of 
the  interior  are  readily  accessible  to  cleaning 
processes,  so  essential  in  a  hospital,  and 
also  are  less  liable  to  accumulate  dirt. 

An  interesting  feature  of  the  construc- 
tion is  the  outside  trim,  comprising  the 
base  course,  water  table,  main  cornice, 
sills,  caps  and  steps.  It  was  intended  to 
form  these  in  concrete,  but  in  order  to 
avoid  the  imperfections  inherent  in  mono- 
lithic concrete  formed  in  place,  such  as 
flaws,  holes  and  a  general  rough  ap[)ear- 
ance,  it  was  decided  to  cast  all  this  work 
in  separate  pieces  on  the  ground,  when  any 
imperfect  casting  could  be  rejected.  This 
was  done,  and  besides  all  exposed  surfaces 
of  the  blocks  were  finished  on  a  rubbing  bed 
to  make  them  more  presentable.  No  at- 
tempt was  made  to  imitate  any  particular 
variety   of   stone,    but   tlie   result   obtained 


hilly    as    sat) 
aj)peai'anic 


.•icf()i-y,    boll:     in 

.■i>    ^urnc   of  the 

while    al    tlie    same 


A(  (>\  i;i!i;i)  i!Ai.(  oN'i.  ni;si'iiAi.  lu  ii.dinci.hhook 

lAX  Cllll.DKENS  AIL)  bOC  IICTV  SKASIDK  IIOMK, 
CONEY  ISLAND,  N.  Y. 

MR.    KDWAIil)   PKARfE  CASEY,   AKCIIITF.CT 


seems   tii   he 

hanlncss  and 

varieties   of   limestone 

lim(>  the  cost  is  very  muc-h  less. 

This  idea  of  finishing  concrete  in  the 
same  obvious  ways  that  stone  is  finished 
is  one  that  is  seldom  practis<'f|.  but  snrelv 
one  material  is  as  (■:iit:\\,\r  as  the  other  uf 
iicing  thus   rendered    more   presentable. 

I'lie  exterior 
surfaces  of  the 
terra  cotta  walls 
;iimI  of  the  brick 
[tiers  and  arches 
>urrouiiding  the 
balconies,  and  also 
III'  the  concrete  and 
tcira  cotta  ceiling 
<>i'  the  first  story 
balcony,  are  stuc- 
coed in  Porth'uid 
cement  mortar  ap- 
[ilied  in  two  coats, 
'ihe  finishing 
coat  was  done 
with  a  rich  mix- 
ture of  white  Port- 
land cement  com- 
bined with  coarse 
white  sand,  which 
gave  a  very  hard,   but    rough   sand   finish. 

More  or  less  difhculty  was  experienced 
in  getting  the  men  to  sufficiently  impregnate 
the  walls  with  water,  and  otherwise  to 
keej)  the  stucco  damj)  until  thoroughly  set, 
but  damp  weather  was  a  great  aid,  ami 
very  little  hair  cracking  is  apparent. 

Experiments  were  made  with  the  fine 
white  beach  sand,  of  which  there  was  an  un- 
limited su])ply.  but  the  result  with  an  e<juallv 
rich  mixture  was  very  unsatisfactory  as 
the  cement  did  not  properly  set  and  the 
stucco  could   be  rul)bed  oft'  as  powder. 

The  floor  covering  for  the  balconies,  as 
well  as  the  main  corridors,  operating  room 
and  milk  laboratory,  is  made  in  granolitliic 
pavement,  with  metal  mesh  im1)edded  in 
the  foundation  to  prevent  cracking,  as 
the  customary  joints  between  sections  were 
eliminated  in  order  to  secure  the  unbroken 
surfaces  so  desirable  in  modern  hospital 
architectural  practice. 


37 


THE  ARTIFICIAL  LIGHTING  OF  HOSPITALS 

Abstract  of  a   Paper  read  at   the  ('oni;re.s.s   of  the   Royal   Sanitar_v   Institute  at  Belfast,   by   Mr.   John   Darcli 


|XY  one  wlio  has  had  in- 
■siaht  into  tlie  work  of 
modern  hospitals  coiihl 
not  do  otherwise  t  h  a  n 
feel  the  <jTeatesi  athiiira- 
tion  for  tlie  sjjlen(hd  ser- 
vice and  effective  ecjiiip- 
nient  that  characterize 
those  institutions;  and 
yet  it  must  be  said  that,  models  of  ele- 
oance  and  hvoienic  forethoneht  as  thev 
are.  their  excellence  is  usually  marred 
liv  the  enoraftino-  thereon  of  svstems  of 
artihcial  liyhtino  tliat  would  justify  a  repe- 
tition of  ]\Iiss  Xiohtingale's  trenchant  o})ser- 
vation  that  "the  very  first  requirement 
in  a  hospital  is  that  it  sliould  do  the  sick  no 
harm." 

Light  (and  in  that  term  radiation  both 
visible  and  invisil)le  must  be  included),  like 
any  other  form  of  ])ower,  may  become  an 
agent  of  destruction  or  a  minister  of  health 
and  blessing  precisely  in  accordance  with 
the  wisdom  shown  in  its  apjjlication;  and 
it  is  the  duty  of  the  professional  adviser,  l)e 
he  architect  or  engineer,  to  understand  all 
that  j)ertains  thereto  before  he  can  pretend 
to  satisfactorily  invest  his  buildings  with 
the  instruments  of  such  a  force. 

There  are  to  be  avoided,  on  the  one  hand, 
the  evils  of  glare,  and  ])articidarly  that 
which,  in  a  ward  patient,  would  enter  the 
lower  part  of  the  eye;  the  evils  of  excessive 
brilliancy,  of  violent  contrasts  of  light  and 
shade,  and  of  the  injiu'ious  and  troublesome 
rays  of  heat  and  actinism;  there  is  also  to  be 
avoided  the  risk  of  eye  strain  consequent 
upon  insnflicicnt  light  or  upon  the  effort 
to  see  in  the  face  of  inisplaccd  lights.  On 
the  other  band,  I  here  is  to  be  sought  the 
comfort  of  a  soft  and  well-diffused  light 
so  arranged  that  vision  ma\'  be  both  easy 
and  pleasant,  which,  after  all.  is  the  proper 
object  of  lighting. 

'J'lic  \alue  of  illuminaliiin  (Icjicnds  no!  on 
the  aniouiil  of  light  llial  is  shed  throughout 
a  room,  but  on  that  which  is  reflecled  from 
visible    objects.     An    essenlial    part,    there- 


fore, of  any  scheme  of  illumination  is  the 
colorino-  of  walls  and  ceilintrs,  the  strenath 
of  which  must  be  properly  balanced  with 
the  amoimt  of  light  availal:)le.  Dark  colors 
eat  up  the  light,  and  are.  therefore,  wasteful. 
^^  hite  ceilings,  cornices  and  friezes  not 
glossy,  with  jiale  tinted  walls  and  slightly 
darker  dados,  will  best  serve  the  hospital 
and  its  inmates. 

Let  us  proceed  to  consider  some  prac- 
tical methods  of  dealing  with  the  subject, 
and  begin  with 

The  Hospital  Ward 

The  average  ward  unit — of.  say,  twenty 
beds- -should   be  provided   with   two  kinds 
of   illumination,    viz.    (1)    general,   and    (2) 
local. 

\.   The  oeneral  liohtiuii'  need  be  no  more 
than  enough  to  see  clearly  about  the  room, 
say.  ()..5  foot-candle. 

No  sources  of  liglit,  nor  any  illuminated 
surfaces    exceeding    0.1    candle-])ower    per 
s(juare   inch    (14   candle-power   per   square 
foot)    sliould    be   exposed   to   the   patients' 
or  nurses'  eyes;  whereas  the  intrinsic  bril- 
liancy of  the 

Gas  mantle  averages.  .        30  c.p.  per  sq.  in. 
Acetylene  flame.  .....  .        40    "      "      "    " 

Electric     carbon      fila- 
ment        400    ••      "      "    " 

Electric    metallic    fila- 
ment  1,000    "      "      "    " 

Direct  illumination,  therefore,  u.seful 
enough  in  the  lofty  outi)atients'  hall  or 
elsewhere,  is  quite  unsuited  to  the  hospital 
ward. 

Direct  lighting  lamps  may,  however, 
be  usi'd  if  pro\i(lcd  with  proper  shades, 
i)ut  everylhing  depends  upon  that  word 
"proper."  (dass  shades  and  all  transpar- 
encies are  inadmissible,  nor  .should  any 
partial  translucency  exceed  the  above- 
named  limil  of  brightness,  while  any  shade 
thai  is  used  should  etfectually  .screen  the 
eyes  without  materially  darkening  the  room. 
If  bracket   liohts    be   used   for  oeueral  li<jht- 


38 


MOD  I-:  l{  \       II  OS  I'  I   I  A  l,S 


WAHD   IN   IIOSPIIAL  Bl'ILDING 

THH  i{c)(  KKi  i;i.i,i;n  iNsrrn  ri;  iok  mi:i)1(:al  reskarch,  m;\v  \()iik 

MKS.SHS.    VOUK   A   SAWVKH.   ARnilTKCTS 


iii<;',  ;i  hair  circle  shade  should  l)e  used  so  as 
to  ilhnuiuate  the  wall.  'I'he  piactical  result 
of  all  this  is  a  soft  all-oNcr  illuiniiialion 
which  is  very  pleasiuii'. 

IIi<;h  placed  ceiling  lio'hts  will  prove 
ecjually  successful  with  a  carefully  calcnlaled 
shadiiii;'. 

Indirect  lii;htiiii;'  liy  means  of  the  in- 
verted electric  arc  is  deservedly  gaining 
favor,  hut  although  it  would  serve  well  in 
many  parts  of  a  hospital.  1  could  not  recom- 
mend it  for  the  waid.  as  the  ceiling  would 
he  too  dazzling  for  those  who  have  to  lie 
on  their  hacks. 

.\  happy  effect  may,  however,  he  ohiained 
from  indirect  lighting,  with  timgsteu  or 
other  metallic  filament  lani|)s,  place(l  inside 
a  .shallow  metal  howl,  white  on  the  inside. 
To  ohtain  the  hest  eH'ect  they  should  he 
hung  as  low  as  convenient,  nor  should  the 
lamp  he  set  too  low   in  the  l)owl. 

Excepting  in  the  wintei',  ai'tificial  light- 
ing is  little  needed  in  the  ward,  for  hospital 
economy  favors  very  early  hours,  liul  vonic 
sort   of  sulxhunl    lighting   is   ni"ci>ssar\    dur- 


ing the  night  watch  all  the  vear  round. 
\\ilh  gas  or  acetylene  a  -mall  hurncr, 
shaded,  on  a  hy-pa--  would  do.  In  electric 
lighting,  several  expedients  hav(>  heen  adojit- 
ed.  hut  a  "^  candle-power  shaded  lam|)  i- 
Ihc  most  economical.  An  cxcclleiit  arrange- 
ment is  indirect  lighting  from  .in  S  candle- 
power  lamp  in  a  small  howl. 

"■2.  Local  l.iijlil niij.  The  sisters'  and 
nurses"  laMcs  should  each  ha\'e  a  well- 
shaded  lamp,  that  i-  adjustahle  in  height, 
so  that  au\  dc-ired  inten-itx  ma\'  he  oh- 
taiiied.  A  comfoital>le  illumination  for 
reading  is  4  foot-candles.  I)ut  Kl  foot-candle.s 
is  not  loo  nmch  foi' some  pui'po-e--.  .V  ifood 
form  of  shade  is  a  dee|i  cone  of  dark  green 
opal,  with  the  lamp  entircK"  recessed.  A 
more  cheerful  form  would  he  one  with  a 
rose  silk  flounce  with  white  lining,  deep 
enough  to  hide  the  lamp,  and  for  cleanli- 
ness the  top  should  he  of  white  opal  gla.ss, 
and  the  Houuce  easily  remo\al)le. 

'i^he  patiiMits"  lights  are  hest  placed  one 
at  the  head  of  each  lied,  hidden  in  a  dark 
green  opal   sluide  and   somewhat   to  the  left, 


3!) 


MODERN     HOSPITALS 


so  as  not  to  radiate  heat  on  the  patient's 
head  and  to  avoid  gloss  in  reading.  An 
ilhimination  of  fonr  candle-feet  should  be 
available.  This  lamp  will  be  useful  for 
examination,  and  should  illumine  the  pa- 
tient's chart.  Near  this  there  should  be  a 
plug  for  a  hand  or  standard  lamp. 

Steadiness  is  an  essential  condition  of 
good  sanitary  illumination,  for  fluctuation 
and  flicker  are  not  only  very  disturlnng, 
but  may  amount  to  permanent  injury. 
This  trouble  may  arise  (a)  from  the  glow- 
lamp  when  used  on  an  alternating  current 
whose  frequencies  are  below,  say,  35  per 
second;  (6)  from  an  arc  lamp  when  the 
light  varies  in  intensity  and  color,  due  to 
imsuitable  or  impure  carbons,  or  when  it 
"pumps,"  due  to  defective  feed  mechanism; 
(c)  from  the  gas  mantle,  due  to  an  ill- 
regulated  air  sup])ly,  accumulated  conden- 
sation in  pipes  or  the  wind  from  the  open 
windows  of  the  ward;  and  {d)  from  all 
flame  burners  by  the  two  last-mentioned 
causes. 

Gloss  is  frequently  as  troublesome  as 
bare  lights,  and  yet  the  majority  of  hospital 
wards  have  shiny  ceilings.  There  should 
be  no  difficulty  in  getting  a  dift'usive  or 
dead  surface  as  sanitary  as  that  of  the  ob- 
jectionable gloss. 

The  Operating  Theatre 

The  operating  theatre  needs  good  arti- 
ficial light,  and  plenty  of  it,  for  there  is  a 
large  proportion  of  surgical  work  done 
after  dark.  It  should  have  a  separate 
general  illumination  with  screened  lamps 
over  the  sinks  and  sterilizers.  The  ceilings 
and  walls  should  be  completely  reflective, 
and  are  be.st  lined  with  close-jointed  white 
glazed  tiles,  with  a  little  relief  in  the  form 
of  a  j)ale  green  or  grey  dado. 

The  illumination  of  the  operating  table 
is,  of  course,  the  leading  consideration. 
The  light  siiould  a|)proximate  to  the  color, 
the  perfect  dift'usion  and  the  high  intensity 
of  broad  davliglit;  both  the  luiisance  of 
overhead  heat  and  the  s('|)tic  risks  of  dust 
collection  .should  be  avoi(k'd,  and  the  fittings 
and  glass  employed  shoiilil  be  pliiiti,  smooth 
and  easily  cleansable. 

It  is  important  that  the  lights  should  not 
all  be  clustered  together,  forming  deep 
and  troublesome  .shadows,  nor  be  situated 


directly  over  the  table  to  worry  the  surgeon 
with  the  shadows  of  his  own  head  and 
hands,  or  that  would  necessitate  the  fre- 
quent shifting  of  the  tal)le.  Yet  these  are 
the  arrangements  most  commonly  met  with. 
Every  hospital  has  its  own  pattern  of 
operating  light  (scarcely  two  are  alike), 
while  many  of  them  are  very  curiously  con- 
trived. The  following  may  be  taken  as 
typical  of  the  more  usual  arrangements: — 

1.  One  or  more  j^lain  shade  pendants 
of  the  common  type,  sometimes  with  a  dust- 
raising    counterweight    and    pulley. 

2.  A  cluster  of  from  two  to  twenty  glow 
lamps  imder  a  large  opal  shade. 

3.  llectangular  trough  four  feet  long 
with  opal  sides,  full  of  lamps,  and  sometimes 
with  a  sheet  of  opal  glass  underneath; 
this  gives  an  excellent  light,  but  the  heat 
is  intolerable. 

4.  A  foiu-  or  six  light  electrolier,  each 
arm  with  a  separate  lamp  and  opal  or 
aluminum  bell  shades. 

Either  of  the  foregoing  may  depend  from 
the  ceiling  or  from  the  end  of  long  swing 
brackets.  Glow  lamps  should  have  metal- 
lic filaments;  tungsten  is  said  to  give  the 
whitest  light.  Gas  burners  are  sometimes 
attached. 

At  Charing  Cross  the  drawback  of  con- 
centration is  well  met  by  distributing  the 
light  over  the  long  arms  of  four  brackets 
and  round  the  gallery  front. 

The  London  Hospital  and  that  at  Ryde 
are  fitted  with  operating  light,  consisting  of 
a  fixed  central  100  candle-power  lamp 
under  an  opal  reflector,  with  four  hinged 
arms,  each  with  a  60  candle-power  Nernst 
lani])  in  a  condenser  tube  projecting  the 
light  to  any  desired  spot. 

Electric  arc  lamps  are  employed  in 
some  continental  theatres. 

Direct  lighting  with  ordinary  arc  lamps 
is  out  of  the  question  on  account  of  the 
unavoidable  shadows;  excepting,  perhaps, 
for  general  lighting,  lint  where  there  is  a 
large  skylight  a  splendid  direct  illumina- 
tion nuiy  be  ol)taincd  from  white  flame  arc 
lamps,  which  have  a  remarkal)ly  high  effici- 
ency, and  throw  most  of  their  light  down- 
wards. Four  of  tliese  ni;iy  be  suspended 
over,  but  not  too  close  to,  the  ceiling  light, 
which  should  be  of  clear  fluted  glass  to 
spread  the  light.  They  may  be  fixed,  or 
may  move  on  rollers  worked  by  cords  in  the 


40 


MODKIIN      HOSPITALS 


room.  (Questions  oF  dust  and  tlic  iiiliiisioii 
of  liurij)  triiiiiiKTs  arc  lliiis  (■limiiialcd. 

Indirect  arc  liii,litiiiji,',  particidarly  wlicrc 
there  is  no  skyliji;lit,  is  eniiiieiitly  suitaMc. 
Four  teii-anipere  open  airs,  properly  f)la<'ed 
and  reflecting;-  directly  a<;ainsl  a  wliitc 
ceilin<;',  would  <;'ive  a  hrilliaiil  illniiiinalidM, 
with  all  the  advantaii-cs  of  da\  litilit. 

Professor  Siedeutopl'  has  invented  an  iu- 
<;enious  arran<;einent  I'or  li<i;htin^'  the  opcrat- 
ini;  table  by  nieans  of  isolated  beams  of 
light,  which  are  not  only  ample  bul  ciilircly 
avoid  the  dust  (juestion. 

There  are  two  forms  of  it : — 

1.  The  siu<>;Ie,  in  which  a  twenty-ampere 
projector,  or  search  light,  is  placed  out- 
side the  theatre,  and  about  seven  feet  six 
inches  high,  from  which  a  jiarallel  beam  of 
light  is  (lirected  through  a  hole  to  a  small 
mirror,  thence  to  the  table,  or  through  a 
second  mirror  to  the  table.  'I'liis  beam  is 
controlled  by  an  iris  diaphragm  and  smoked 


glass.  It  is  best  suited  to  tin;  gynecological 
and  throat  theatres.  It  is  necessary  to  have 
good  general  lighting. 

"■2.  The  compound  foriii  i-.  more  .-.alii- 
faclorv.  .\  piojcctor  lamp  as  before,  but 
of  twenty-five  to  thirty  amperes,  directs  the 
light  through  an  aperture  to  a  thin  metal 
disc,  on  uiiicli  arc  placed  small  flistriliuting 
mii'rors  which  di\Idc  tin-  main  licam  into 
a  munber  of  smaller  ones,  and  which  are 
sc|)aratelv  projected  to  receiving  mirrors 
placi'd  arounii  the  room.  These  mirrors 
reunite  the  light  on  the  table  in  a  many- 
sided  form,  free  from  shadows. 

Electric  fuse  wires  have  a  knack  of 
'Agoing"  at  most  inoppoi-tunc  moments, 
while  a  l)reakdown  on  the  part  of  a  ^up[)ly 
conij)any  is  not  unknown.  It  is,  therefore, 
essential  to  have  a  reserve  for  such  an  emer- 
o-encv.  The  fusin<r  trouble  is  more  common 
on  branch  circuits;  one  excellent  precaution, 
lliercfoic.     will     be    found     in     wiring    glow 


WARD    I.\    ISOLATION    Dl   1I.I>IM; 


THE  HOCKEFELLER  INSTITUTE  FOR  MEDIC.\L  RESE.\RCn.  NEW  YORK 

MESSRS.  YORK  &  SAWTER,  ABCHITEOTS 


41 


MODERN      HOSPITALS 


lamp  fittinos  from  two  separate  main 
branches,  either  of  which  failing,  enough 
light  may  l)e  left  to  work  bv. 

To  provide  against  failures  on  tlie  main 
there  are  two  methods: — 

1.  A  gas  lamp  witli  an  inverted  mantle, 
as  at  the  West  London  Hospital,  which 
should  he  lit  during  o])erations. 

2.  An  electric  accumulator,  from  which 
a  small  emergency  lamp  sliould  he  kept 
alight  during  oj)erations.  and  in  connection 
with  which  it  should  be  possible  to  immedi- 
atelv  switch  on  sufficient  light  from  the 
accumulator  to  comj)lete  an  oijeration.  Sep- 
arate lamj)s  would  l)e  required  for  this 
purpose  unless  it  would  be  convenient  to 
have  the  voltage  of  the  accumulator  etpial 
to  that  of  the  circuit. 

Some  hosjiitals  keej)  oil   lamps  ready  to 

hand. 

Hand  and  standard  electric  lamjts  of  a 
varietv  of  i)atterns  are  to  l)e  found  in  every 
operating  theatre. 

Thk  Dispens.\ry 

is  nsuallv  the  worst  served  of  any  depart- 
ment. It  is,  in  London,  frecjuently  to  he 
found  in  the  basement  or  in  some  other 
part  of  the  building  lacking  daylight,  while 


the  artificial  illumination  is  commonly  so 
inade(|uate  that  it  sometimes  becomes  a 
difficulty  and  a  worry  to  read  the  prescrip- 
tions. 

A  properly  shaded  light  yielding  four 
or  five  foot  candles  is  recpiired  to  each  man 
on  the  dispensing  benches.  The  shelves 
should  be  illuminated  with  .screened  lights 
to  facilitate  visual  acuity;  in  fact,  no  bare 
lights  should  be  visil)le.  Lndoubtedly,  the 
inverted  arc  lamp  with  a  white  ceiling  would 
aft'ord  the  best  ilhimination.  while  the  run- 
ning cost  of  it  should  com])are  favorably 
witli  that  of  glow  lamps. 

Nothing  is  more  jn-oductive  of  eye  strain 
than  the  effort  to  (leci]>her  any  kind  of 
graduated  .scale,  but  with  the  faint  lines 
of  a  glass  measure  in  the  twilight  of  the 
average  dispensary  held  uj)  to  a  patchwork 
background  of  bottles  the  strain  is  increased. 
It  would  save  time  and  afford  conffort  if 
small  white  screens  were  fitted  u|),  one  in 
front  of  each  luan,  adjusted  to  catch  the 
chief  incident  rays  from  a  skylight  or  win- 
dow at  such  an  angle  that  they  reflected 
towards  the  dis])enser.  The  same  screen 
could  be  used  under  an  artificial  light  or 
in  a  permanently  dark  situation,  or  there 
should  be  an  illuminated  panel  of  either 
reflec-ted  or  transmitted  light. 


ST.  VINCENT'S  HOSPITAL,  INDIANAPOLIS,  IND. 

MESSRS.   D.   A.   BOnLP:X  &  .SOXS,  .ARCIIITKC'TS 


HIS  building  is  h)cated  in 
the  center  of  a  large  i)ark- 
likc  s(|uare,  well  relieved 
with  trees  and  shrui)bery, 
overlooking  Fall  Creek 
and  its  boulevards.  It 
is  accessible  from  Four 
^ides,  being  bounded  i)y 
the  most  proniiiuMit  drives 
of  the  city.  The  location 
is  ideal  and  lends  itself  admirably  to  the 
((uiet  and  restful  beauty  so  desirable  as  a 
backuround  for  an  institution  of  this  char-  I 
acter. 

The  building  is  designeil  lo  be  fir<'|>i'o(ir 
and  as  sarntarx'  as  modern  means  of  coii- 
■struction  will  allow.  The  exterior  is  of  dark 
pres.sed   brick,  grarling  from  a  heavy,  som- 


ber coloi'  on  the  first  floor  to  a  lighter  and 
more    livelv    one    above,    the    whole    beino- 


lelieved  with  a  rather  free  u.sage  of  Indiana 
limestone.  The  floor  con.struction  is  of 
reinforced  concrete  slabs  bearing  on  out- 
side and  inside  brick  walls;  these  walls 
I  icing  designed  heavy  enough  to  practic- 
ally eliminate  all  noises  from  penetrating 
into  the  rooms.  Throughout  the  entire 
liuililing,  sanitary  base,  made  flu.sh  with 
the  plastering,  is  used,  and  all  ceilings  and 
wall  cornel's  are  coved.  ANOod  floors  are 
o  lie  used  in  the  rooms  and  terrazzo  floor.s 
and  wainscoting  in  the- colridnrs  and  ■oper- 
ating suites.  All  doors  are  flush  panel, 
inlaid  veneer  doors,  and  the  hardware,  etc., 
is  designed  as  simple  as  possible  to  avoid 
even  the  smallest  lodging  for  dust. 


-42 


MODERN       IIOSITI  A  I.S 


Sj)Cfiiil  attciitioii  li;is  hccii  p.iid  lu  llic 
arriiiij^ciiu'iit  of  rooms.  'I'lic  nuilliw  est 
wiiio-  l)('Iiiir  (Icsioiu'd  entirely  lor  I  lie  per- 
niiiiieiil  aileiiduiils  of  llie  iMsliliilion.  'The 
haseiiient  of  lliis  |)arl  heini;'  cold  .slora^c 
rooms;  first  door,  kitelieii  and  serving 
rooms;  mfiin  floor,  Sisters'  diniii<i'  rooms 
and  comimitiity  room;  second  floor.  Sisters" 
apartments;  third  floor,  nurses'  apartments. 
TJie  north  or  chapel  \viii<j  contains  wards 
for  nervous  |)atients  on  the  lirsl  floor, 
administraiion  offices  on  the  main  flooi', 
and  the  chapel  and  j;aller\  on  the  Icxcl 
of  the  second  floor.  The  soiilh,  \ve>l. 
east  and  center  wings  are  devoted  to  wards 
and  semi-|)rivate  rooms  on  the  first  fioor 
and  private  rooms  on  the  main,  second, 
third  and  fourth  floors.  Fyiitirely  over  the 
main  building  and  completely  isolated  from 
anv  of  the  other  parts  of  the  building  are 
the  operating  rooms,  with  their  necessary 
etherizing,  sterilizing,  .r-ray  and  rest  rooms. 
This  floor  also  contains  laboratories  for 
analyses,  crematory,  scrub  rooms  and  re.st 
rooms  for  physicians  and  tuirses.  There 
are  also  emergency  op(>rating  suites  scat- 
tered  throughout   the   buildings,   which   arc 


dcsign<,"d  just  as  completely  a>  tlio-.e  on  tjie 
operating  floor.  'Ihc  roof  garden  extends 
o\('r  the  entire  building  and  affoi'ris  a  de- 
lightfulK-  <)uicl  place  for  |)alients  to  enjoy 
the   fresh    aii'. 

The  building  is  e(|uip[)cd  with  large 
sterilizing  >!ills.  so  that  all  the  water,  both 
hoi  and  cold,  irsed  on  Ihc  operating  flooi- 
and  such  other  places  as  arc  deemed  riec- 
cssar^,  is  distilled.  The  buihling  is  auto- 
maticalK  anil  nu'chanically  heated  and 
ventilatecl.  Kach  room  being  e(|uipped  witJi 
large  outlet  flues  fi-om  \\hi<-h  the  foul  air 
is  drawn,  thu>  chan<i'inii'  the  air  liii ouiihout 
the  entire  building  every  few  nu'nutes. 
y\1I  of  the  plumbing  fixtures  are  of  the  late.st 
approved  types  of  hospital  lixlurcs  and 
throughout  tJie  operating  suites  foot  and 
knee  action  fixtures  are  to  be  used. 

In  con jimction  with  the  hospital  building 
|)roper,  a  large  power  house  and  laundry  is 
being  erected.  'I'his  building  is  two  stories 
high  and  is  divided  into  a  boiler  room, 
in  which  three  1.30  iior.sepower  Kitzgibbons 
high-pressure  boilers  are  installed;  engine 
room  and  laundry,  including  the  necessary 
washing   I'ooni.   drNcrs,    ironini;-   looms,   etc. 


HAYNES  CONTAGIOUS  BUILDING.  BHKiHTON,   MA.S.S. 

ME.SSR.S.  KKXDAI.I..  TAYLOR  *  .STKVKXS.  .IRCIIITECTS 


43 


CO-OPERATION  IN  HOSPITAL  PLANNING 

By  M.  E.  McCALMONT,  R.N.,  Hospital  Specialist  and  Consultant,  Former  Supt.  Civil  Hospital,  Manila,  P.  I.     Chief,  Division  of 
Hospital  Construction  and  Equipment,  Bureau  of  Health,  Philippine  Islands. 


iX  this  practical  age  the 
ultimate  test  of  every 
proposition  is,  not  so 
much  what  does  it  cost; 
is  it  the  newest  thing; 
or  what  do  the  critics 
and  others  think  of  it; 
but  how  does  it  v/ork;  is 
it  practical ;  does  it  stand 
for  the  essentials  of  effi- 
ciency   and    economy    of    service? 

And  this  is  the  working  test  to  which  our 
modern  hospital  planning  and  construc- 
tion must  be  submitted.  The  architects 
are  giving  us  smooth  interiors  and  artistic 
exteriors.  Many  of  them  are  becoming 
indeed  expert  on  the  subject  of  rounded 
corners  and  angles,  flush  surfaces  and  a 
general  absence  of  projections,  and  yet 
we  feel  that  these  institutions  are  not  yet 
all  that  might  be  desired. 

That  "the  hospital  is  for  the  patient" 
has  become  an  axiom  beyond  dispute. 
But  no  hospital  is  successfully  constructed 
for  the  l)enefit  of  the  patient  unless  also 
constructed  for  the  comfort  and  conveni- 
ence of  the  entire  working  ])ersonnel.  No 
patient  is  receiving  fair  play  from  a  hospital 
which  has  faulty  working  machinery;  where 
jars,  breakdowns  and  confusion  are  liable 
daily. 

In  view  of  this,  the  question  is  pertinent — 
are  our  hospitals  practical  from  a  icorkincj 
standpoint? 

Who  is  to  answer  this,  the  architects, 
trustees  and  doctors,  or  the  superintendents, 
and  working  staffs .-' 

The  arcliitcct  may  be  an  excellent  judge 
of  the  dural)ility  of  the  latest  flooriug,  and 
competent  to  |)ass  upon  all  the  technical 
details  of  hospital  construction  and  finish, 
but  can  we  expect  him  to  know  the  details 
of  hospital  management  sullicienlly  to  cope 
with  its  peculiar  and  practical  needs. ^ 

The  trustees  or  boards  of  managers  may 
be  able  to  see  that  a  hospital  is  clean  and 
quiet,  and  be  able  to  recognize,  in  practice, 
smoothly    running    hospital    machinery,    or 


its  opposite — but  can  they,  from  their  casual 
visits  to  the  hospital,  be  in  a  position  to 
locate  an  inconvenience  of  arrangement 
which  may  be  the  occasion  of  daily  con- 
fusion ? 

The  doctors,  through  visits  to  their  pa- 
tients, may  know  whether  orders  are  being 
carried  out  or  not;  whether  j)atients  are 
improving;  or  whether  they  are  satisfied 
with  their  surroundings  and  treatment. 
But  if  tlieir  patients  are  uncomplaining, 
can  they  know  that  a  lack  of  improvement 
may  be  due  to  sleepless  nights  caused  by 
noisy,  banging  doors;  crying  babies  who 
should  always  be  in  sound-proof  rooms; 
the  too  near  proximity  of  utility  rooms, 
bath-rooms  or  diet  kitchens.'  Can  they 
know  that  their  patients  are  getting  cold 
meals  because  a  diet  kitchen  is  not  adapted 
or  planned  for  efficient  service;  that  a  com- 
plaint of  lack  of  attention  may  not  be  be- 
cause there  are  not  enough  attendants,  but 
because  very  often  hospital  planning  neces- 
sitates an  unwarranted  expenditure  of  time 
and  eft'ort  in  the  way  of  service.'' 

These  persons,  doctors,  trustees  and  ar- 
chitects, are  obviously  not  in  a  position  to 
fully  appreciate  all  the  working  needs  of  a 
hospital  for  the  simple  reason  that,  usually, 
they  have  never  worked  in  one.  Yet  they 
are  the  persons  upon  whom  we  must  de- 
pend for  the  planning  of  our  hos])itals. 
Where  there  has  been  co-operation  good 
results  are  generally  noticeable,  but  very 
seldom  is  a  superintendent  seriously  con- 
sulted in  matters  concerning  which  often 
he  or  she  alone  knows.  Yet  this  same 
superintendent  will  be  expected  to  find  a 
way  out  of  the  difficulty  after  the  error  is 
committed  and  the  building  comj)leted. 
Rarely,  if  ever,  are  the  various  heads  of 
de[)artments  called  in  for  an  expression  of 
opinion  concerning  subjects  upon  which 
they  are  sure  to  have  practical,  if  not  tech- 
nical, knowledge. 

Never  has  the  writer  known  of  hospital 
plans  being  submitted  to  the  student  nurs- 
inj:    body    for    suaji'estion    and    discussion. 


44 


MOD  I-:  u  \     II  ()>  r  I  r  a  ls 


^'(■i  ll  is  .•iliiiosi  ccrljiiii  siicli  ;i  in'occdiii-c 
would  (li'jiw  loilli  iii,iii\  cxccllcnl  sii^jics- 
lioiis.  I  ,'irii  ciiiilidriil  lli.'il  fcwci'  ilici 
Uitcliciis  with  llicir  iiicx  il;dilc  noise  woniil 
!(('  phiccd  iicxi  Id  llic  wjirds.  ;is  is  so  (il'Icii 
(lone,  il  nurses  or  sn|ierinlen(lenls  were 
eonsniled  :dioMl  llie  iiri'an^'enienl .  I  iini 
;ds(>  snr("  tlie\'  would  ;isk  lor  ;i  I'easoindile 
nnmlier  of  sonnd-pi'oof  isolalion  rooms 
willi  pfoperly  t;ii;inle(l  windows.  Tlieirs 
is  lln'  |)erson;d  responsihijih  for  delirious 
patients,  and  such  a  i'e(|iiest  would  lia\c 
io  he  lieeded.  ^'et,  lauienlahU  ,  few  of  sueli 
rooms  exist  I 

Would  it  not  he  as  well  to  ask  a  dielisi 
what  is  to  u'o  into  her  diet  kitchen,  and  plan 
aeeordin<;l\ ,  rather  than  laliel  a  tonr-walh^l 
room  "diet  kitchen"  and  attempt  to  jikne 
the  manifold  necessities  tliei'c  after  the 
linildin^'  is  completed.'  It  would  seem  that 
such  lack  of  co-operation  is  larg-ely  res|)on- 
sihle  for  a  not  utiusual  arran^^-nient  of 
"•as  .stove  and  ice-l)ox  side  l)\  side,  with  a 
necessary  serving  table  or  drain-hoard  hir 
the  sink  omitted  altogether  for  want  of 
room.  Who  hut  the  ilietist  would  he 
liahle  to  think  of  the  convenience  of  ha\iug 
her  meat  hlocks  ])lace(l  near  the  cold  stoi- 
au'e,  and  her  kitchen  so  arran<i'ed  that  hiod 
trucks  might  be  expeditiously  loaded  w  ithoul 
distnrl)ing  the  jiersonnel  or  working  nia<  liin- 
erv  of  the  kitchen  itself.- 

(.'an  not  the  pharmacist  best  tell  u^  of 
arraiigcnients  which  would  facilitate  his 
work;  of  the  most  convenient  relation  of 
sinks,  working  tables,  tablet  machines, 
dispensing  connters.  etc.,  etc..-'  Would  it 
not  he  better  to  allow  him  a  voice  in  such 
matters,  rather  than  have  them  aihitrarily 
ari'anged  by  persons  wlio  could  not  l)i'  ex- 
pected to  have  a  woi'king  knowledge  of  the 
facts,  and.  incidentally,  would  never  ha\c  to 
sutl'er  from  the  inconvenience  ami  annov- 
ance  which  follow  a  thoughtless  arrange- 
ment oi-  choice  of  C(pii|)ment    and    facilities.- 


11  a  ^npeiiutendent  of  nurses  wen*  con- 
^nltecj    \\i    the   matter  of  a    nui'-cs'   home,   is 

II  not  prol)al]|e  llial  nii^lit  nur-e-,  would  he 
pro\idcd  with  ^onnd-pioof  rooms  located 
in  a  section  of  the  building  farthest  re- 
moved from  duiiui;  rooms,  lecture  rooms, 
halhs,   elc..- 

'I'lie  docloi's  alwa\-<  lia\c  ade(|nale  dress- 
uig  rooms,  lockei's.  shower  halh>.  etc.,  in  an 
operating  pa\iliou,  while  a  similar  pro- 
\ision  is  seldom  if  excr  made  for  nurse>. 
\  f\  nur-c>  nia\  he  perspiring  through  two 
or  three  opci'alions  to  the  <loclor  s  one,  and 
woidd  ha\c  e\'en  greater  ap|)i-eeiation  of  a 
pi'oper  dressing  room  and  showci'  than  he. 
If  the  chief  operating  loom  nui'^e  were 
asked  for  sutiiifstiou^  in  the  planninir  of  an 
operating  |)avilion.  i>  it  not  prol,>aljle  that 
she  would  ask  that  these  things  he  proxided 
for  her  stall'  as  well  as  for  the  doclors.- 
.Vlso,  would  she  not  piotot  ai:ainst  having 
her  instrument  cases  placed  in  the  sterilizing 
room,  as  is  so  often  done.-  Would  not  her 
supph  I'ooni  lie  much  more  con\cnient 
and    acce.ssihic    than     ihe    Usual    Inst    .spare 

III  lie  iililr.rd  wliK-h  i>  labelled  "".supplies," 
and  then  left  to  it^  -ad  and  unsatisfac-tf)rv 
fate.- 

riie  loregoing  i'ri'or>  and  man\  .-imilar 
ones  are  actually  I'oimd  in  the  plans  of 
some  of  oui"  best  hospitals.  1  he\  are  not 
necessary,  and  it  is  believed  that  a  friendly 
co-operation  between  arcliitects  and  head> 
of  hospitals  and  heads  of  the  various  dc- 
|)aitmeuts  of  the  lios|)itals  would  .see  fewer 
and  fewer  commilt<'(l.  Such  co-operation 
would  undouhtedly  develop  a  most  whole- 
some esprit  ^\r  corp-  among  Jiospital  t'us- 
tees,  ofhcials  and  employees.  All  \\ould 
then  he  working  for  the  completion  of  an 
iirstitntion  both  beautiful  and  .serviceable: 
iutelligent  in  detail;  and  adapted  in  its 
everv  re(|uirement  to  the  great  pni'pose  of 
efficiently    earing    for    the    world.s    afflicted. 

Does  it   not   seem   woith  the  expeiiment.' 


43 


m 


]\\g\\a\\n\\c 


||D][n]0[c 


110 


A  TROPICAL  HOSPITAL  ADAPTABLE  FOR  TUBERCULOSIS 


/)'//   M.    K.   McCALMONT,   llo^pilal   Specialist   aii;l   Consiillaiit 


jX  every  tropical  eouiitrv, 
there  are  certain  ])eculiar 
and  apparently  in.sur- 
niountai)le  problems 
w  h  i  c  h  confront  those 
whose  duty  it  is  to  pro- 
vide hosj)ital  care  and 
acconmuxhition  for  the 
>i(k  natives,  foreio'ners 
and  government  employ- 
ees. Class  distinctions  and  race  prejudices 
are  encountered  from  the  start  and  must 
he  handled  delicately  or  the  ensnin<>;  fric- 
tion will  bring  the  working  machinery 
to  a  halt  at  most  inopj>ortune  times. 

Probably  every  hospital  built  in  a  ti'0|)ical 
country  must  needs  be  general  in  character 
— that  is,  must  lie  I'eady  to  take  care  of 
medical,  snroical  and  obstetrical  cases, 
with  ])rovision  for  isolation  in  case  of  an 
unex])ected  communicable  affection,  (ien- 
crallv  the  officers,  employees  and  nurses" 
training  school  have  to  be  accommodated 
and  suital)ly  provided  for.  Sexes  and  races 
have  to  be  separated,  making  at  the  least 
four  distinct  wards  with  well  separated 
toilets,  lavatories,  etc.  To  include  these 
manifold  needs  in  one  building  and  for  a 
niininnim  amount  of  money  is  a  ])robU'in 
which  has  vexed  iiian\  of  those  who  have 
cast  thcii-  lot   in  ti-oiiical  countries  to  battle 


with  the  numerous  health  and  sanitary 
problems  to  be  found  there. 

The  plan  which  is  shown  accompanying 
this  article  is  the  result  of  exjjerience  and 
of  a  great  deal  of  thought  given  to  the  subject 
by  the  writer. 

"Thorough  ventilation"  has  been  the  slo- 
gan, and  has  been  accomplished  by  the 
ward  wings  with  three  exposures  and  the 
interior  open  court,  which  .should  of  course 
be  jjrovided  with  a  constantly  playing 
fountain  to  cool  the  air  in  the  heat  of  the 
day.  The  chief  value  of  the  plan  is  its 
adaptability  and  elasticity.  The  many  di- 
visions can  be  adapted  to  peculiar  local 
conditions  found  any  place  in  the  tropics, 
while  the  general  arrangement  can  he 
retained  though  the  structure  be  l)uilt  in 
varying  cajiacities  and  according  to  vai-ying 
appropriations. 

The  wards  can  be  enlarged  w  ith  increased 
funds  witliout  disturbing  the  administrative 
section. 

Sexes  and  races  are  easily  .separated. 
The  capacity  of  the  hospital  is  practically 
doublefl  by  removing  the  convalescents 
to  the  upstair  loofs  where  they  should  re- 
(juire  little  oi-  no  nursing  attention  and 
where  they  are  out  of  tlie  depressing  at- 
mosphere of  the  acutely  sick. 

Native   traininii'   schools   foi'   both    voun^ 


1    1''    I  ,rlr,  •'  I  /  .    ■    ,         ■■    '(    f 


-^-1 


.-lA 


~::\ 


•'ro;;t  IL^'.'.vnoN 
I'lioi'K  Ai.  no^rriAi, 


k; 


M  ()  I)  i;  I,*  \     II  ()  -  !■  I  r  \  i,s 


incii  Mini  WDiiicii  ,ii<'  Iiciiil;'  sI.iiIciI  hi  ;iI 
most  ('vcr\  lii)|)i(;il  cuiinlrN.  Mic  |)l;iii 
sliowii  |)i-()\i(lcs  ii  (loriiiilorv  fur  Im(||i. 
It'  tlic  ti'iiiiiini^'  school  iiiclii<lcs  oiils  wumcii. 
one  (joriiiilorN  iiuiy  lie  iis<-il  for  llic  cxlr.-i 
iiiiilc  ;itt('ii(iiiiits,  uliicli,  ill  siicli  cvciil. 
would  !)('  ii('<-('ss;ir\ .  \iiiscs.  |)ii|iils,  .md 
(•iii|)lo\ CCS  all  li;i\'c  sc|)aralc  rools  lor  open 
air  sleeping',  a  in'aciicc  wliicli  is  hciiij;-  more 
and  iiioi'c  encouraged,  and  wliicli  in  I'acl 
|)la\s  an  im|>orlanl  |)arl  mc\('r\  cdiicalional 
licaltli  campaign.  I'^oi'  linndreds  ol'  vcais 
ccrlain    siiperslilioiis    and    fears    lia\e    kepi 


orrict   '/■\T.r>TfccLti  7  carter. 

Vi, 


I'KOI'lc    \l,    IKKlM  lAI. 


liall\c  liiiii^e>  lii^lilU  c|o~c(|  al  lii;^lit.  to 
which  I'acl  iiia\  he  lar;^el\  a  1 1  lihiited  llio 
wide  pre\alcncc  oi'  liil)ei'ciilo-.i^  in  tin* 
IMiili|)pine^  and  in  other  similar  tropical 
count  lies. 

The  capacil\  lor  employee-  may  he 
ciilariicd  l)\  pulling  a  -ecoiid  -loi'V  over 
the  k lichen  pavilion,  hill  Mil--  i>  iiol  dcsir- 
ahle  as  the  kilclicii  proper  >hoiild  he  two 
stories  III  lieiiihl.  lo  make  il  hearahle  diiriii;^ 
llie  hollc-l  season.  A  heller  a  rra  Ii;^cnielil 
wolllil  he  lo  hiiild  a  lliircl  me,\pen>l\i' 
hiiildini;'     which     coiild     he     utilized     I'oi-    a 

laundry,  tool  house, 
disiiifcctiii;:  plant, 
mrinerator,  ele.. 
and  w  liicli  could  al- 
>o  mchitle  accom- 
modatioii.s  for  any 
.servants  not  pro- 
\ided  fill"  ill  the 
main  hiiildiii:^-. 

'i'hi-  ho-pital  in 
the  dime  n>ion  s 
sh(i\\ii  was  planueil 
a >  a  remi( irced  c( m- 
crclc  >l  ructure,  esti- 
mated lo  cost  ( with 
a  lai'Ljc  proportion. 
Ihouiih  not  all  of 
its  e(|uipmenl)  .SHO.- 
(tdd.  Labor  con- 
ditions, etc..  vary 
lo  such  an  extent 
that  it  is  impossil)le 
to  make  a  more  ac- 
curate estimate  ap- 
pl  lea  hie  to  other 
sect  lolls. 

1 1  a  larger  sum 
is  available  and 
greater  capacity  de- 
sired, the  plan  is 
easily  expanded  by 
a<lilinj^  an  extra 
room  on  each  side 
of  till'  central  ad- 
ministration section 
and  iucri'asinii'  the 
Icuutli  and  breadth 
of  the  wards  ac- 
cordingly. 

For  convenienee 
and  economy  ot"  ad- 
ministration    the 


ArODEU  X      ITOS  1'  1!  A  I>S 


value  of  the  ari'aiiueineiit  is  evident.  So 
coneentrated  is  this  featui'e  that  the  inini- 
inuin  amount  of  hihor  from  a  small  stati'  will 
take  eare  of  a  large  number  of  patients. 

AS    A    TUBKRCULOSIS    HOSPITAL 

A  tro|)ieal  hospital  for  general  purposes 
and  a  tuliereulosis  hospital  foi'  a  tenipei-ate 
region  have  two  great  points  in  conunon. 
Heating  of  the  wards  does  not  have  to  l)e 
consideied  and  plenty  of  air  is  the  chief 
concern.  l'\)r  these  two  reasons  atone, 
the  ])lan  shown  is  very  adaptable  for  cases 


(  crt; 


snggestec 


in    cnaiigcs    may    he 
though     local    needs 
even    ditl'erent    modifiea- 


ot  tuliereulosis 
made,  as 
may  necessitate 
tions.  Airy  wards,  warm  dressing  rooms 
and  a  maximum  amount  of  sunlight  are 
demanded  in  the  construction  of  a  tubercu- 
losis hospital.  It  does  not  seem  possible 
to  get  more  suidight  for  all  wards  than  by 
the  ai-rangement  shown  in  the  accompanv- 
ing    |)lans. 

I  he    convalescents    can    be    moved    up- 
stairs  to   the  roofs,  which   may   be  covered 
with    awning    or   enclosed    by   glass.      If    a 
larger  hospital  is  de- 
sired, a  thiid  story 
can   be  added   with 
pi-actically       t    h    e 
same     aii'angement 
of  wards  and  rooms, 
or  if  |)rivate  rooms 
are   more   desirable 
than        wards       the 
wings       could        lie 
broken  up  into  pri- 
vate rooms. 

As  a  tuberculosis 
lios|)ital,  oidy  the 
administrative  cen- 
ter would  require 
heat  ajid  for  such 
a  hos])ital  in  a  cold 
climate  the  central 
coni't  would  ])i-ob- 
ably  lia\-e  to  lie 
domed  instead  of 
being  left  o])en.  A 
lar<ie  ylass  skvliyht 
whicli  could  be 
opened  in  summer 
might  be  feasible 
and  desirabl(>. 

Details  of  con- 
structit)n  of  course 
provide  for  roimded 
corners  and  angles, 
s  niool  li  sni'faces, 
and  a  general  ab- 
sence of  projec- 
tions. In  addition 
lo  Ihc  regular  doors 
I  lie  rooms  ar(>  pro- 
wilh 


\lilc<l 


lie 


so- 


I  Hoi'K  \i,  iiosi'rrAi, 


ca  1 1  (Ml  I  la  r-  TOO  III 
doors  which  allow 
ventilation  dav  and 


48 


M  ()  I)  i:  ij  \     II  OS  I'  I  I  \  I, s 


iiii;lil,  \('l  siilliricnt  l\  -.ciccii  llic  \lc\\  I'oi' 
ordiiiarv  piiiposcs.  Mvcrylliiii^'  [lo^sililc  in 
tlic  \\;i\'  III'  still  i()?i;ir\'  (M|iii|)riiciil  Is  luiill  (ill 
tlic  (Iddi's,  (ir  HI  (illicr  \\(iril>.  Mis|icn(lc(|  IVuin 

lIlC    Willis. 


'I  lie  |ii;ili  l>  cDMilJicliilcil  to  tlic  lii)i|jil  a  I 
wdi'M  lur  till'  iiii('i|ii:ii('ri  aiiioiiiit  oi'  air  and 
^llIlilL;■|||  III  all  >ri-linn-.  ami  t'lir  tlic  ar- 
raiiijciMciil  wliicii  ic|irc~ciit  -  iniiiiuiiiiii  ser- 
vice Willi  ma  \  nil  II  III  II '^1 1  Its. 


45) 


MODERN    HOSPITALS 


PLATES 


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M  ()  I)  K  R.\      II  OS  I'  I   lA  LS 


THE  NEW  HKI.I.EVrE  HOSPITAL.  NEW  YORK 


MESSRS.    Mr  KIM,    MF..\D   *    WHITE,    ARCHITECTS 


PLATE  2 


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AT    lilOlll         ISOLATION    m;ilJ)l\(;  Al'    I-OIIT        IIOHI'MAI,    lllJH.mNO 

MEHSKH      VOUK    A    HAWVl  ]i.    Aid  illTKOTS 

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MKSSU.S,    HHRPI.KV,    lUITAN    A    COIILIIm;!;.    AliririTKCTS 


TJIE  1KHKK1-'ELI,E11  IXSTITL  TE  F()|{   MEDICAE  HESKAI{(  11.    NKW  VOKK 

ri.AI'K  .-> 


M  ()  I)  i:  K  \     II  OS  I'  I  r  A  Ls 


THE  ROCKEFELLER  LNSTITUTE  FOR 

MEDICAL  RESEARCH, 

NEW  YORK 


M  to[j  is  ii  gciK-ral  view  sliuuing  the  three  builtlinj;s 
constitutint;  tlie  group.  At  left  is  the  laboratory 
iMiilding,  of  wliieli  Messrs.  .Sliepley,  Rutan  &  Cool- 
iiige  were  the  architects.  In  tlie  centre  is  the  isola- 
tion building,  am!  al  tlie  right  the  hospital  building. 
These  two  buildings  were  designed  bv  Messrs.  York 
iS:  Sawyer,  architects.  .\t  left  is  a  picturesque  view 
of  the  hospital  building,  with  a  glimpse  of  the  isola- 
tion building.  This  view  is  taken  from  the  Ejisl 
River. 


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jt-JH-i-  1 r  .L  U  U    H. — PTTTm        H  U  J    f    1   J-   A_  L 


HOSPITAL  BUILDIXO 


THE  ROCKEFELLER  LNSTITUTE  FOR  .MKl>RAL  Ri;sEAR(  H,  NEW   YORK 


MESSRS.  YORK   *  SAWI  ER     ARCHITECTS 

PLATE  7 


M()l)i:i{\     II  OS  I'll' A  LS 


JtVENTH    rLOOP^PLA.N 


HOSPITAL  nriLDi.vn 
THE  R()CKEFEI,I,KU  IXSTriTTE  I'OIJ  MEDU  Al,  UKSEAIU  11.  NEW    YORK 

MESSRS.  YORK  *  SAWYER,  .AJICHITECTS 


I'LATK   S 


M  ()  1)  i:  H  \     IIOS  I'  I  TA  l<S 


HASEMF.NT   KI.ODR    IM.A.V IS(1I.VTI(>N  uni.DINO 


THE  RO(  KKFELLER  INSTITUTE  FOR  MEDICAL  RESEARCH,  NEW  YORK 

MESSRS.  YOKK  A  SAWYER,  ARCHITECTS 

PL.\TE  it 


MODKRX     IIOSI'ITALS 


NURSES'  HOME.  MKMOKIAI,  IIOSl'ITAI..  MACAKA   I'AI.ES.  \.  V, 

MESSRS.  GREEN  4  WICKS.  ARCHITECTS 


PLATE  l»i 


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■Jlcoajd  •  rtooG  •  Plau- 


FIRST  FLOOR  PUV-S" 


NURSES'  HOME,  MEMORIAL  HOSPITAL,  MACiARA  FALLS,  N.  Y. 

lltaSRS.   GRFE\   A    \M<  K-S,  ARCHITECTS 

PLATE  U 


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NtESSRS.  GREEN  A  WICKS.  ARCHITECTS 
PL.\TE    U 


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PLATE    15 


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BARNARD  SKIN    AND    CANCER   HOSPITAL,  ST.   LOUIS,   MO. 

.VJESSBS.    MAOIAN    *   RrSSF.LL.    ARrHITECTS 


PLATE  ii 


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BAKXAUl)    SKIN    AND    CANCER    HOSPITAL,  ST.   LOl  IS,   MO. 

.MESSRS.  M.\URAN  *  RUSSELL,  .ARCHITECTS 


PLATE  25 


MOD  K  K  .\       II  OSITI  A  LS 


SURGICAL  BUILDING,  NIAGARA   FALLS  .MEMORIAL   HOSPITAL 

llESSRS.  GREEX  4  WICKS,  .UlCHITECTS 

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y   7. 


'r-     % 

^     - 

Z 


X 


I'LAIK 


MODE  UN      IIOSIM'IALS 


?''wr.r'Tii'..ii'. 


F^"   F    F  F  F    fif 


IH 

'If 

1 

*BW 

P 

P^ 

!whk1 

,t. -,■"•'     ■■■•     :«! 


FIRST  rtOOR  PIAH 


^ii^'^_Sjil''"-^-&'__ --4— --. _i^ 


9^*t£j. 


iSi^i^;;;:t!:tti«v:i4 

ADMIXISTHATION-    liril.niNG 


iECOND  nOOP  PLAN 


CINCINNATI    (JEXEUAI,    IIOSITPAL,   CINCINNATI.   O. 

MtaSKS.  SAMl  Kl.  IIAWAFORn  A  SONS,  .mcHITECTS 


ri.vn:  -.'s 


MODKKN       IIOSI' I   I  A  I.S 


WAHI)       II 


CINCINN.Vl'l    (iKNKIJAI.    IIOSIMIAI 
CINCINNATI,  (). 


^TM?. 


,.[I3.vL-.-f^--ilrx 


.■'^>-  ta 


ii.X. 


g=cil 


HasT    riooa  Pla/^ 


ISOLATION    WARD    KOK    MILD    FORMS    OF    CONTAGIOLS    DISEASES 


MESSRS.   SAMUEL   HANNAFORD    4   SONS 
ARCHITECTS 


MALE    WARD  FOR   SKIN    D1SE,\SES 

PIATE  29 


MODK  UN       llOSl'l'i'ALS 


TVI'K  AI.   WAi(I)   I)UII.DIN<;S 


t  -iVsJ?   c=>   C3    trj   en  C3   c:3   ca    cr»   c=> 


dj    tf     V    *~*    t— f    £3    i^V      VSy    t     r    "^     »    *T» 


c 


'^^ 


li, 


r«.-Ai*i:fi7,rft'^tj«i*:i 


T 


0         D 


ta^ 


Fffl 


tU^  .  Ic^  ^ 


;a.ST       FLOOR.       PLAN  TYPICAL       V/AR.D       SUILD'.NG 

fHE      NE7/     GENERAL     HOSPITAL     CltlClMt'AT'     -'^y-O 

iAMUEL     HANNAFOB.D     AND      jONS     AR.CHITECT5 


0 


0 
0 
D 
0 
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a 


KITCHEN  AND  SERVICE  BUILDING 

CINCINNATI  GENERAL  HOSPITAL,  CINCINNATI.  O. 

MESSRS.  SAMUEL   HANXAFORD   *    SONS.   ARCHITECTS 


PLATE  3U 


MOD  K  I{  \      IK)  SIM  I"  A  I.S 


m 
O 

J 

s 


P      ■< 


PLATE  31 


M()I)KI{\       IIOS  I'l   r  A  I>S 


ST.  MNCENT'S  HOSPITAL,  IXDIAXAPOLIS,  IND. 

MESSRS.  D.  .V.  BOHLEX  4  SONS,  -ARCHITECTS 

PLATE  Si 


.M  Oi)  i;  1{  .\       11  ()>  I'l   TA  l,S 


-.__.  ^ ■^-*^-. 


.pw  A*4  ■O''-  PoapTf  -p_oo«- 


>  I 


*  mJ^^"*-'^  ♦ 


PI.ATK  ;s:! 


M  ()  I)  K  l{  \       IIOS  I'l  I  A  I,S 


PI.ATK  :u 


MOD  I',  R  \       II  OS  I'  I   I'  A  LS 


!^:.^-h 


il----;     ii-.-j(if..'      t-.-i  J--^  i--^         i 


rRONT  Ct.CVACnON 


l_t-.Uj-.— II-.L.-I. L-i-  -li'i.   <.t-.-i  ii  .1  '.U  -4--1  -II.JILI  I   ':  iTf 


!.-i        t  -  i 


RCWJ   CLCX^TIOK. 


'2..s''~'~i7Sl~~~}.c~t^jSic^~~'I~-i'^'^Tc'~'^ Si'    „■  X"""- 


B   f   T:'  :B-   '" 


C--1  .'.-i    r:5  -ii  i-.i 


SIDE  CLCVATION. 


I Q  QQQQ 


i^   E-i  i!-'; 


*  j«-*--t"  i4-«  tt«a  tj    <  >t»*t^ 


nr^ 


nn 


■^ 


SECTION  N.lf-3. 


m  ;.=•- 


=.--?E=!El 


iKkspiTAi,  mn.niNG 


l?lt()()KI.^  N   (  llll.l)l!F\'S  AID  S()(  IK'I'>-  SKASIDK   HOME,  COXEY  ISf-AXD.  \.  V. 


MH.    I   l>\\   M(l)    PKAUCK   (  ASKV.    AUCIIITKIT 


I'l.AlK  :i.-> 


M  ODKIIX       II  OSniA  LS 


iKjepiTAi,  inii.Ki.vi; 

iil!()<)M.^\    (  nil  |)l!l,\^   All> 

SOCIETY  SEAS  II  i  i:  1 1  ( )  M I ; , 

CO\E'\'  ISI.WI)   \.V. 


MR.  EDWAIU)  I'EARCE  CASEY, 

Al!(  IllTECT 


PI.ATK  30 


MOD  K  l{  ,\       II  OSri  lA  LS 


fiiR.-=<DC-~i 


SccrioN  THRouGtt  Suction  through:  Section;  through 

PlAZZ>^  ArCHC.3  W>J.I..3  aNChCor  PiA2.?A^.  RCAJi  CxTEMSION    WALT-. 


IIospil'M.  i:l  ir.liixc 
lUiOOKI.IN  (  llll,l)l!i;\S  All)  S()(  IKTV  SKASIDK  llOMK,  (  OM'A    ISLAND.  N.  V, 

Ml!.    l.IIU  Mill   IM  AKIK   C.V.SKY.  .AWHITKCT 

I'LATIC  37 


M  ()  I)  K  |{  \       II  OS  I' I  T  A  I,  S 


y. 


-■     ^ 


ri.ATi-;  3s 


M  ()  I)  i;  K  \     II  OS  r  I  r  A  i.s 


^ 


In  ^nVj' 
i  \  '  -■J 


^W 


liAKKMKNT  A\l>  I'lltfiT  KI.DDK    I'l.AN 


EMEH(;EXrV  IIOSPITAl..   HII  FAI.O.   N.   V 


MKSSKS.  ghi;i;n"  a  wuks,  ARrmTHi  ts 


1'I.ATK  ;S!) 


M  ()  I)  K  l{  \       II  OS  I' I   I  A  I,  S 


!ifei^ii:iiraa3S^t£j^&±i 


SECOND  AND  THIRD  FLOOR  PLANS 


EMERGEXf  V  HOSPITAL,  BUFFALO.  \.  Y 


MESSRS.   (iREE.V   A   WICKS,  ARCHITECTS 


PLATK    411 


.M(Jj)i:il.\       IIOSITIA  I.S 


WOMEN'S    MKDK  Al.   AM)   SIIMMCAI.   HI  JI,l)I.\(i.    1{KAI)F()|{I )    IIOSIMIAI,.    HltAI  )l  ( )l!l).   I'A. 

MicsNUs.  (ini:i:\  a-  wii  ks.  aik  hit  kits 


MEN'S  MEDICAL  AM)  SURGICAL  BTILDLXG,  BRADFORD  HOSPITAL.  BRADFORD,    PA. 

MESSRS.  GREEN  i'wiCKS,".*HCHITECTS 


PI..VTr.  41 


M()i)i;u.\     ii()>i'irALS 


MA'I'KUMl'V    lUII.DlN"..  liKAl  )l'()l!l )  I  lOSl'IIAI..    IJIiAl  )l()l!l ).  PA. 

MlvSS».S.   (IUKKN   .V    WICKS.   AKI  EIITKCTS 


if  II 


-^^K  £^ 


u-ii ;. , .. 


IXTKItlOIi,  WOMKNS  WAIil),  l?l!ADl"(inil  IIOSITIAI..  HHADFC  )l!l).  I'A. 

MESSliS.    GHI-.EX    .\;    W  l(  K.S.    AUl  1IHK<  T 

I'LATi:  4-' 


MODERN       IIOSniA  LS 


»h^'"^ 


H"Lij    ilfealJ     r..:i 


MATEHNITV  HI  Il,l)l.\<i,  BRADFORD  IIOSJ'I'IWI.,  RRADFORD,  I'A 

MESSRS.  GREEN  4  WICKS,  ARCHITECTS 


FIRST   FLOOR   PUN 

( )  1'  E  R  A  T  I  X  G    Ij  L  I  L  D  1  N  G 
BRADFORD  HOSPITAL. 
BRADFORD,  PA. 

MESSRS.   GREE.V  4   WICKS,   ARCHITECTS 


Pl..^  IE    43 


MODERN      IIOSI'llALS 


rl.OT   IM.AN 


151iAI)K()l{l)  IIOSPITAI,.   IJKADFOHl),   I'A. 

MKSSHS.   GREEX   i   \M(  KS,   AK(  linK(  T.S 


FIRST   FLOOR   I'U^X 

MEXS  MEDK  AL  AND  SURGICAL  BUILDlNXi.  BRADFORD  HOSPITAL,  BRADFORD,   PA. 

MF-SSRS.  GREEN  4  WICKS,  ARCHITECTS 
PLATK   44 


_^^K- 


M()I)i:i{N       II  OS  I' I 'I"  A  LS 


=71 


J 


^15?™,..^ 


.StCO-ND     TLOOE    PLAAJ 


M 


ADMINISTRATION  UlILDIXG,  BRADFORD  HOSPITAL,  BRADFORD,  PA. 


MESSRS.  GREEN  &  WICKS,  ARCHITECTS 


PLATE  45 


MOD  !•;  |{  \       ll()^  I*  I   I  A  LS 


k  'r- 


^m'\     Tl^S^ 


'*^^a 


3»»- 


-  --^.:?^ 


j^:- 


j..^-*^>;--J-«S^^.V, 


^    - 


X. 


PLATE  46 


MC)T)KI{X      HOSITIAI.S 


_       y^. 


PLATE  il 


MODE  l{  N      II  OS  I' I  r  A  I.S 


U 


! 
1 


^ 


Cjz 


< 

w___        •] 

G 

■  ■    -.■'•''l 

.^l 

^1 

c^mm^.A 

(_'TO^'  1 

it^y\^_j^  r 


iir.orK  PLAN 


MLXKirAl.  HOSPITAL  FOR    I'llE   DlSI'ltK    T  Ul    ( Oi.lMlUA 

MESSRS.  FR.VNK  MILliS  DAY  A  BROTHER.  ARCHITECTS 
PLATE    4S 


MODKKX      IIOSI'J'l'A  LS 


■  j£'*JF^«Wliii 


*  K^^^^H.  ' 

c 

R.       1. 

■ 

■     via             ^- 

1 

ffiHr    I 


y. 


PLATE  49 


M()i)Ki{\     iiosrri'ALs 


--t: 


M 


■P: 


1  r 


! 
1 


3  ?n»  j'.!!s  1./,      .     .. 


< 
s: 

o 
o 

O 

1- 

y 

H 

Q 
uu 
X 
h- 

Qt: 

O 

u. 

-li 
< 

H 

o 

X 


T-l^'^ 


P 


l:^::^ 


n       <  ! 


J 


I'i.ATE  50 


MOD  K  l{  \       II  OS  I' I   TA  LS 


lli^ 


^! 


Si 


a         — 


>.'       i. 


S 


I'L.VTK  ,->l 


M()l)i;i{N       IIOSriTALS 


ri.Aii;  .v2 


MODKItX       IIOSI'I'I' A  I,S 


PLATE  53 


MOD  !•:  I{  \       II  OS  I'  I   r  A  LS 


AmmUTEfcTIOH    EKMI-DINC 


l{K\"KKI,V  IIOSriTAI..  Hi;\i:i!I.^,  MASS. 

-Mli.    KlIWAHt)   I-,   STKVK.N.S,  AR(  IIITKCT. 


I'LATK  .54 


M()i)i:i{.\    JiosrriALs 


ADHINDTEATION    BUILBUO 


BEVERLY  HOSPITAL.  HJ:\  ERL\,  .ALVSS. 

MR.   EDWARD  F.  STEVKXS,  ARt'HITECT. 


PLATE  55 


MOD  K  i:  \     II  OS  I'  I  r  \  [.s 


PLATK  .-M 


:\IOI)K  I{  \       II  OS  I'  IT  A  I,  s 


■  ADOITIO^TO 

•GRACE- /HOSPITAL 

•DETROIT       MICH  leA  N  • 
■tDWAeO   F    5TCVeN6    AECHITtCr 

BOSTOM  AiASSACHu  strrs 


I  n  SI  -7     BED     WAED 


C     O      ft-      R-        I        t»        O  E- 


I     VVAR.O 


fo      RfcL  P      WAICO 


DDD 

-r    BCD    WAC  o 


*■>-■— ~"  «i^ 


I 


PLAN      OF       F  I  R-ST- r=LOOR- 


KITCMCN 

E-XTSNSIOH 


r/CWICC   YAR.D     ■houJE 


IfiirjiuiMU    mr^i.L 


C      O      K.       R.        I  O  O  K^ 


STOtA&p-    FOE    PCY    CJCOCECIE-"" 


P  LAN   •  OF-    BASEMENr      FLOOe. 


I'l.ATl-:  57 


MOD  !•:  I!  \     II  ()>  r  I  I  \  i.s 


eijev.; 


DIET 
KITCHEN 

■        U  I-  J 


J 


BALCONY 


^ 


PKIVATt  Ch"  0 


PRIVATE   KM. 


PRIVATE  K.'m  tj 

lal      I 


Q 


m  a 


■  ADDITIO/i  TO  • 

•GRACE  /105PITAL- 

■DETROIT        MICHI&AN- 
•  COWARD  F    STEVENS    ARCHITECT 
•fS05T0AI-  /"^ASSACHUiETri- 


Li 


/lUtSES 
UTILITY     EoOM 


PEIVATC  EM 


LTD 


'^.r*  womK       U    toilet        p  m 


iC 


PRIVATE 


D' 


I  PeiVATfc   UM 

IK'  1 


PRIVATE  eM 


C 

o 

(?. 

e 

1 

D 

o          c 

1 

n 

^^ 

■  n 

■^ 

^ 

J 

P  (C 1 VA  TEJ 

^  FK-tVATE 

^    FCtVATL-  1 

^FEIVATf- 

F-ClVATt 

^ 

rtMVATl- 

EM 

" 

EM 

1 

RM 

CM 

R,M 

%Xth 
o   @ 

f-Mf— 

1 

^ 

' ' 

1— 

H 

^^^H         ^1 

■IB— -1 

■■■ ■ 

imm I 

■§■ 1 

■ ■ 

^^ 

1 

P  L  A  N      OP   •  5E.CON  Q    FLOOR- 


I  F 


I  • 


Pt  O  OF- 
GrAtOfc*  A4 


r  F 


r  •  • 


X 


1        •         * 


SEE    TEXl     FilH     IHIHD    Fl.'lnH    IM.W 


y 


•P  LAH-  O  F-    KOOP  • 


I'j.Ari-;  58 


MOD  K  l{  \       II  OS  ri  'I'  A  l,S 


tr 


"y  f-"  rn  rn  rrt  r"  ^"^  i 


-=*=« 


llAKI'i;i!     II  OS  I'll- A 


DK'IM!  orr.    M  1(    II 


MKSMH.S.   MAl.COMSO.N  &   I1I(.(;1M10T1I AM,  AK(  IMTKl  TS. 
MH.   KDWAKD  F.  STKVEXS,  COXSfl.TI.NC;  Al<(  IIITKCT. 


I'l.ATK  Ji) 


M()I)KI{\       IIOSI'I'IALS 


y 


y.    *= 


—    < 


—        2 


?        t 


r. 


V. 


PLATE    (id 


MOD  K  l{  \       II  ()<  I*  I   I    \  l,S 


r.      A 


< 

X 


i'l.ATK  (il 


.MODK  K  .\       II  ()>  I'  I   lA  LS 


y 


I'LAIK   KH 


M  ()i)K  n  \     ]]()>  r  IT  A  1. 


■aKt^a&'jj 


■-mi^s^s^s£££-,- 


STAIF,    ASYLIM    KOK    TIIK    CIIROXIC    INSANE,    WERNERSVILLE.    PA. 

.MESSRS.     H.WKl.N,    KKI.l.OGC:    A     fK.V.VE,    .UiCHITECTS 

PLATE  oa 


MODKHX       IIOS  ITI' A  LS 


|-^  f-i     '  ^t 


» 
x 


S5 


X      ^ 


.-    ^ 


SG 


.1   J- I    I 

CJI  '.  luj::li:j  ,  icj  . 

II  II 


I         I-  :  •      -I         I 

II  II 


n 


:  ii 


>■ 


PLATE  64 


.M()J>Eli.\       IIOSITIALS 


(  OiNNECTING     ARl  ADK 


STATE   ASYLUM   FOR   THE   CHRONIC    INSANE,    WERNERSVILLE,    PA. 

MESSRS.    R.\XKIX.    KELLOGG    &    rR.\XE.    .ARCHITECTS 

PLATE  65 


ivi  o  I)  !•;  i{  \      iKx  I- 1  r  A  I, 


ff'v 


PLATE  66 


MOD  K  |{  \       II  ()>  r  I   I  A  I.S 


MECONI)  KLOOK    IM.AN 


THOMAS    MEMOKIVI.    KOSl'I'l" Al.    KOK    (ONSIAIPTIVES.    MIXXEAPOLIS.    MINX. 

MESSRS.     HEWITT    \-     BKOWX,    AHCIIITErTS 

PLATK  67 


M()i)i;i{.\  ii()>rn  Ai.s 


/ 


y 
y 


y 


f. 
y 


y    I: 


O     < 
>     £ 

^     a 
z 

■2    3 


X      ? 


X 


X 


PT.ATE  68 


M()I)KI{\  IIOSIM'IALS 


t: 


1 

[i.i 


r"T.r"i 


«--» 


LUL  J 


/< 


X       < 


X 


•r 


^' 


I'l.Aii;  (111 


M()l)i;i;\   IIOSIMTAF.S 


y. 
y. 

'A 


y. 


■f. 
y. 


z     y    1 


li_... 


'A 


y 


y. 


-^■,;V^tS-s  ■^v,-"Vgil 


ri.AlK   70 


MOD  K  K  \      II  OS  I'  IT  A  I, 


I'OGRAPHIC^X      ?iAAP 
i-JLj; 2_E 


sANAtORlUM 


COOL 


AEc-D-    Bb-\w -J-   Drv  I-*- 


THE  COOLEY  FAUMS  TrHEHClI^OSIS  SAXATORIUiM.  WARREXSVILLE.  OHIO 

MK.    J.    MILTOX   DVER,   ARCHITECT 


PT.ATE   71 


M  ()  I)  i:  i{  \    II  OS  I'  I  r  A  Ls 


r-f-tt 


^mmm 


t&SMi 


o 
(4 


> 

Z 


-u 

> 


s 


x 


u 


PLATE  72 


M  ()  I)  K  K  \     II  OSri'l  A  LS 


lr---S^^.!t:cr;.;:nr,;. 


rit/r    rLooE.   ?iA/t 

ATIMIVISTOATION'    lU'ILniNC 

TlIK  CO()l.l•;^    lAK.MS    1  IBKliC  I  I.OSIS  SANA  r01{H  .M.   W  AHI!KNS\  ILl.i:.  O. 

\11(.  .<.   .\llI.Tf>\  DYKJl    AKCHITECT 


ri.AI'K  73 


M  <)  I)  !•;  i:  \   II  o>  1'  I  r  A  i.s 


i     '^    z 


I'l.M  i;  n 


M  ()  I)  l-;i{  \    IIOS  I'  IT  A  LS 


u 
^ 


a: 


< 

^ 

^ 

n 

- 

rT 

x; 

^ 

— 

>'. 

^- 

p 

*-• 

:.: 

c 

Vj 

> 

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'/) 

"" 

■ir 

H 

O 

8 

J 

S 

d 

S 

en 


>- 

8 


PLATE  75 


modi:  K  N    IIOSIM'I  A  LS 


IMMAXArOIIS.  INI)..  CITY  HOSIM  I'AI. 

MU.   ADOI.l    SI  III.HKER,   ARCHITECT 


PLATE  76 


MOD  !•;  I{  \    II  OS  I'  I 'I'  A  LS 


ff 


\nMi.\bi L\i ins  liMiDiM- 

PLAN  (ir    nXit-MF-ST 


ADNflNLSTUATIOS     IMr.DI\'C.. 

n.  vv  iir  HOT  FtiKC 


iNDiANAroi.is.  iM)..  (  ir\  ii()>rir.\i. 

MK.   ADOI.F  SOHERKKU,   AH(  niTK(  T 


I'l.Ari-; 


M  ()  I)  !•:  li  \   II  ()-  I'  I  i  \  i,> 


\i)MiMMi;\iii'\    iMiniM' 

I'L  V\    OF  THrHI  riiXK 


IXDI  WArol.IS.  IM).  (  IIV  IIO-riTAL 

\IH.    ADDl.K  S(  llKliUKK.   AKClllTtCT 


ri.M'K  78 


M  ()  I)  i:  i{  \  ii()>  ri  r  A  i,s 


'V/;0\L    ^AKD 


INDIA X.VrOLIS,  IXD..  CITY  HOSPITAL 

.MK.  ADOI.K  sc  tlKHUKK.   AUI'IIITKIT 


i'LAll-;  7!) 


M  ()  1)  i;  |{  \     II  OS  I'  I   I  A  LS 


■: 


-   J 


-e- 


nnt^: 


i[l>_^^ 


ii 

ii 


PLATE  80 


M  ()  I)  i;  l{  \     II  OS  I'  I   I'  A  I.S 


y.    = 


A 


I'LAi'i:  SI 


modi;  i:  \  II  ()>  I*  n  \  I 


o 
g 


L. 


/f:::iipr-  ''-dy 


o 

CD 

< 

2 


k 


,  ■„  '    h-i  I-  I" 

i  ■ 


f. 


.  ..Ji 


IT  Alio  85 


M  ()  I)  i:  u  \   II  o^  I'l  r  A  i,s 


•-  •  1- 


J     i—\ 


..     _  .^   J 

^1 

-4 

f  s 

=      1.    -    T 

■■r^ 

..J 

^ 


n 


if.  . 


■+. .  J 


V 


bH 


L_rj 


J 
1 


.■L±±* 


0^^^?5j 

Z 

Q 

t 

[■   ""' 

;:3 

cQ 

O 

z 

b 

1 

^ 

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Ci. 

O 

1 

^- 

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• 

I — -_J 


tn-  --^1' 


,-■  n 


\\ 


I    It 


i:-  tt " 


V-  - 


1 


H 


I- 


k 


H    i^ 


~\ 


.at 


X 


PLATE  83 


M  ()  I)  K  l{  \    II  OS  I'  I  I'  A  I.S 


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PLATK  84 


INDEX 


TKXT  ARTICLES 

MiinianI  Skin  ;i]i(l  ('aiiicr  I  losjiihil,    I'lic,   Maiii'aii  iS;  I'laiiiiiiif;.  ' 'o-i)|ii-rali<)ii  Ijj  ll(i>|jilal,  15v  M.  ]■'..  \]i('ul- 

IJusscll,  ArcliiU'cIs Mi              iriorit,   l{.   N'..   Hospital  Specialist  anri  ('oii.sultant, 

('"iilafrioiis  (Jn.iip  of  llic  I'lox  iilciu  e  Cily   ll((s|iital.  I'lirincr    Sii|.cnMlc?i(li-?it    <^"ivil     ILispilal.    Manila, 

Messrs.  Martin  \-   Hall.  Aicliilcits M               ■'      '■     'lii''''     Division     of    IIos|.itai    forislniction 

DHailsan.l    l-:,|ui|n,rnl   „r  lles|,iiMls,   liv   K.Kvanl    K.  '""'     '■■M"M'""-"I-     ''urc .f     Ilraitl,.     I'hilippine 

Sl,.v,.ns. 1  '"'^""'^ ■»+ 

llcatinfr  and  Vontilafion,  Modern   I'raeliee  in   Ilospi-  Si.  Nineenl's  Hospital.  Indianaj.olis.  Ind..  Messrs.  D. 

tal,  Rv  Clarence  W.  Williams II  A.  Bolden  &  Sons,  .Vrcliilerts U 


lleatiif,'  and    X'cntilation.   Some    Essentials  of   Hospi- 
tal, Hv  !)•   !)•   Kind)all 1!» 


Seaside    llospit.il    of    lli<'     Bronklwi     rhildren's    Aid 

Soriely,  Surf  .\\<'nne.  Coney  Islaiiil.  \.  Y.,  K<lwar<! 

I.i'ditiiig,  Hospital,  Bv  ]•].  H.  Bostock '.id  n     '       i  •  v     i  ■.     i  » • 

'^        "  ■  •  I  earce  (  asey.  .\rclntcci .H 

I,ii^htinif  of  Hospitals,  'I'lic  Artificial.   .Vl)slra<l   of  a 

I'aper  Bead  at  llic  Connress  of  the  itoyal  Sanilarv  Tropical  Hospital  .Vdaplable  for  Tuberculosis,  \.  By 
Institute  at  Belfast.  By  .lolni  Darcli .'!H  M     ''■     McCalinont.   Ho.sjMtal  Speciali.st  and  Con- 
Modern  Hospital.  The 17 


sultant +(i 


New  General    llos|>ital.    ('incinnati.    ( )liio.    Messrs.  N'aruum    Cleam'tif;   Systems   a    Desirable   Feature   in 

Sanniel  Han na ford  1*^:  Sons.  .Vrcliitects 18  M oiler n   Hospitals 17 


PLATES    AND    TEXT    ILLUSTRATIONS 

.\mslcnlam   Hospital I'a^'c   .">  Detroit  (icncral  Hospital.  Detroit.  Midi.          Plates  46,47 

Barnard  Skin  and  Cam  er  Hospital.  Si.   I  .on is.  Mo  Dresden   Hospital Page  (> 

l'af,'c   K;  Kmcrf^cncy  Hospital.  Bufl'alo,  \.  V Plates  38.  ;?9.  4(1 

Plates  ■i-i,  -i:i,  -ii.  -i.'t  (Jencral  Hospital.  Nurses"  Home.   Bnlf.-do.  \.  ^■. 

Bellevue  Hospital.  Xew,  New  York Plates   I.  ^i.  :{.  4  I'li'l*'   '^ 

Beverly  Hospital,  Beverly.  Mass Pages  1.4.  S         <'™<t'  H.ispilal.  D.troit.  Mich Pages  7,  !> 

i'lalcs  .-..!.  .-.4.  :,:,.  .■)(!  Plates  .57.  .58 

Bradford  Hospital,   Bradford,  Ba.  Harper  Hospital,  Detroit.  Mich Plate  o9 

Plates  41.   t'.2.  4.'i.  44.  4.-)  Haynes  Contagious  Building.  Brighton,  Mass...  .  I'age  43 

Brocton  Hospital.  Broc  ton.  Ma.ss Pages  'i-0         Ileywosxl  Hos|)ital.  (iardner.  Mass Page  4 

Brooklyn  Children's  .Vid  Society  Seaside  Home,  Coney  Indianapolis  City  Hospital.  Iiulianapolis.  Ind. 

Island,  \.  Y..  Hospital  i?nilding        P.igcs  ;!4,  .'!.5,  :?(>.  ,'!?  Plates  TC.  7T.  7S.  7!».  S(l.  SI .  S-J.  S.'!.  84 

Plates  . ■!.■,.;!(!.  ;i7  .lohns  Hopkins  Hospital                                                    I'.itrc   i 

Children's  Hospital.  Buffalo.  \.  Y Plates   1:!.  I  t.  l.")  Municipal  Hospital  for  the  District  of  (  ohimlna. 

Cincinnati  (ieueral  Hospital.  Cincinnati.  Ohio  Plates  48.  4!),  .5(1,  .51 ,  .55 

Plates  '>7.'^S.'.2!).  ;i(l.:!l  National  Home  for  Disabled  \dhinteer  Soldiers.  .lohn- 

Cooley  Farms  Tuberculosis  Sanalorium.  Warrenville,  son  Citv.  Tciui Plates  68,  69.  70 

Ohio Plates  71.  ~~i.  ?.'!,  74.  7.5         Niagara  Falls  Memorial  Hospital Page  15 

Corey  Hill  Hospital.  Brooklinc.  Mass Page  3  Plates  1(1.  lI.;J(i 

S.) 


MODERN   HOSPITALS— INDEX 


Providence  City  Hospital,  Providence,  R.  I. 


St.  Vincenf.s  Hospital,  Indianapolis,  Ind.  Plates  .SS,  .'58..S4 


Pages  30,31,32,33         Stainford  Hospital,  Stamford,  Conn. 


Plates  16,17,18,19,20,21 

Qnincy  Hos|)ital,  Qnin(  y.  Mass P''g''  " 

Plates  3,5,36,37 
Rockefeller  Institute  for  Medical  Research,  The,  New 

York Pages  39,  41 

Plates  5,  6,  7.  8, '.) 
.St.  Georg's,  Hamburg Pages  .5,  7,  9.  10 


P 

Pages  12,  19,  20,  21,  22,  23,  24.  2.5 

State  Asylum  for  the  Chronic  Insane,  Wernersville, 
Pa Plates  60.  61,  62,  63,  64,  6j 

Thomas  Memorial  Hospital  for  Consumptives.  ]\Iin- 

neapolis.  Minn Plates  66,  67 

Utrecht  Hospital.  Holland Pages  2,  3,  6, 10 


INDEX   TO   ARCHITECTS 


Bohlen,  D.  A.,  &  Sons Plates  32,  33,  34 

Casey,  Edward  Pearce Pages  34,  35,  36, 37 

Plates  35,  .36,  37 

Day,  Frank  Miles,  &  Brother Plates  48,  49,  50,  51.  .'52 

Dyer,  J.  Milton Plates  71,  72,  73,  74.  75 

Freedlander.  J.  H Plates  68.  (19.  70 

Green  &  AVicks Page  15 

Plates    10.  11.12,13,  14,  15,  26,  3S,  ,39,  40,  41,42,  43,  44,  45 

Hannaford,  Samuel.  &  Sons Plates  27.  28,  29,  ,30,  31 

Hewitt  &  Brown Plates  06.  ()7 

Kendall.  Taylor  &  Stevens Page  43 

McKim.  Mead  &  White Plates  1.2,3,4 

MalcouLson  &  Higginbotham Plate  59 


Martin  &  Hall Pages  30,  31,  32,  ,33 

Plates  16,17,18,19,20,21 

Mauran  &  Russell Page  16 

Plates  22,23,24,25 
Post,  George  B.,  &  Sons. 

Pages  12,19,20,21,22.23.24.25 

Rankin,  Kellogg  &  Crane Plates  60.  61,  62,  63,  64,  65 

Scherrer,  Adolf Plates  7(;,  77,  78.  79,  80,  81,  82,  83,  84 

Shepley.  Rutan  &  Coolidge Plates  5,  6 

Stevens,  Edward  F Page  7 

Plates  53.  54.  5o.  50.  57,  58,  59 

Stratfon  \-  Baldwin Plates  46,47 

York  (St  Sawyer Pages  .39,  41 

Plates  5,6,  7,8,  9 


8(i 


Modern 
Hospital 
Equipment 


:^m: 


results  from  the  utilization  of  the  world's  most  famous  ideas. 
The  evolution  has  been  constant  and  the  progressiveness  in 
design  makes  it  possible  for  us  to  guarantee  the  efficiency  of 
each  apparatus. 

The  great  advance  which  lias  In-ous^ht  hos|)ital  e(|uipnient  to  the  present  stage  is  due  to  our 
close  co-operation  with  the  profession,  and  the  conscientious  adherence  to  high  principles. 
Throughout  the  manufacture  of  our  products,  standards  of  workmanship  and  material  have 
been  established  which  are  exclusive  to  The  Kny-Scheerer  Co.'s  goods.  It  is  because  of  this 
feature  that  ours  are  the  matchless  products.  Tlicy  are  the  products  which  are  preeminent  in 
the  medical  mind  and  satisfy  the  discriminating. 

The  complete  equipment  of  Hospitals  is  a  specialty  with  us. 
Our  lines  are  the  most  extensive. 

They  comprise 
Surgical  Furniture  and  Surgical  Instruments. 

Sterilizing  Apparatus 


Disinfecting  Apparatus 
Physio-Therapeutic  Apparatus 


For  Instruments,  Dressings,  Water,  Utensils,  Bed-Pans, 

Dishes  and  Cutlery. 

For  Mattresses,  Bedding.  Clothing.  Etc. 

By  Steam  or  Formaldehyde  Gas. 

Comprising  the   famous  Zander  mechanically  operated 

Exercises,  Massage,  Vibrators,  Etc. 
Electric  Bakers  of  the  Tyrnauer  System  for  Gout,  Rheumatism,  Sciatica,  Etc. 
Electric  Light  Baths,  X-Ray  Apparatus,  Hydro-Electric  Baths. 
Hydrotherapy  Control  Tables,  Shower,   Needle  and  Sitz  Baths,  Dent's 

Constant    Temperature    Flowing    Baths.     Massage    and 

Shampoo  Tables. 


..j^ 


1  A  ? . 


'-¥ 


I  \  FORMATION  and  specifications  relating  to  any 
Apparatus  will  be  sent  upon  receipt  of  your  request, 
and  at  your  command  are  the  services  of  the  most  care- 
fully organized  corps  of  hospital  specialists. 


The  Kny-Sheerer  Co. 

Alantifacturers  of 

Sursiical  and  Therapeutic  Instruments 
and  .\pparatus. 

404-4 1 0  West  27th  St.,  New  York 


University  of  California 

SOUTHERN  REGIONAL  LIBRARY  FACILITY 

Return  this  material  to  the  library 

from  which  it  was  borrowed. 


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